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HYDROTHERAPY 


A  WORK  ON  HYDROTHERAPY  IN  GENERAL 
ITS  APPLICATION  TO  SPECIAL  AFFECTIONS 
THE  TECHNIC  OR  PROCESSES  EMPLOYED 
AND    THE   USE    OF    WATERS    INTERNALLY 


BY 

GUY  HINSDALE,  A.  M.,  M.  D. 

Secretary  of  The  American  Climatological  Association ;  Lecturer  on  Climatology  in 
the  !Medico-Chirurgical  College  of  Philadelphia ;  Fellow  of  the  College  of  Physicians, 
Philadelphia  ;  Corresponding  Fellow  of  the  Royal  Society  of  Medicine  of  Great 
Britain,  Balneological  and  Climatological  Section,  and  of  the  International  Antituber- 
culosis Association  ;  Ex-President  of  the  Pennsylvania  Society  for  the  Preventon  of  Tu- 
berculosis ;  Member  of  the  American  Neurological  Association  and  of  the  American 
Academy  of  Medicine 


ILLUSTRATED 


W 


PHILADELPHIA    AND  LONDON 

W.    B.    SAUNDERS    COMPANY 

1910 


Copyright,  1910,  by  W.  B.  Saunders  Company 


PRINTED    IN    AMERICA 

PRESS    OF 

W.     B.     SAUNDERS     COMPANY 

PHILADELPHIA 


TO 

2)r.  Milliam  ©sler, 

REGIUS  PROFESSOR  OF  MEDICINE  AND  STUDENT 
OF  CHRIST   CHURCH,  OXFORD, 

AS    A    TOKEN    OF    THE    AUTHOR'S    REGARD 


PREFACE 


No  modern  text-book  on  a  medical  subject  can  appear  as 
the  complete  product  of  a  single  mind.  In  the  evolution  of  a 
medical  work,  especialty  one  on  hydrotherapy,  we  have  an  art 
and  a  science  whose  beginnings  stretch  back  for  two  thousand 
years.  The  genealogy  of  such  a  work  reaches  through  ages  of 
empiricism  to  the  great  minds  which  gave  medicine  its  earlier 
start — ^to  Hippocrates,  Galen,  Celsus,  Aretseus,  Musa,  Paulus 
iEgineta,  and  Oribasius.  The  Roman  baths  were  one  of  the 
great  features  of  that  great  empire,  and  were  established  in  its 
most  distant  possessions.  Only  last  year,  a.  d.  1909,  in  the 
ancient  town  of  Bath,  in  England,  there  was  a  restoration  of 
the  Roman  bath  as  it  existed  in  the  time  of  the  Caesars.  The 
baths  of  Rome  became  so  sumptuous,  and  entailed  such  extrav- 
agance, that  they  eventually  lost  their  h^'gienic  features,  and 
contributed  to  the  decay  of  the  Roman  character  and  bodily 
vigor,  so  that  in  the  dark  ages  that  followed  the  nobler  uses  of 
water  were  neglected.  Only  within  the  last  two  hundred  years 
has  light  begim  to  reappear,  and  only  within  the  last  fifty  years 
has  a  scientific  system  of  hydrotherapy  been  evolved. 

As  the  science  exists  to-day,  supplemented  by  the  use  of 
modern  apparatus,  it  is  a  powerful  aid  in  therapeutics,  rapidly 
growing  in  popularity  as  the  knowledge  of  its  technic  becomes 
more  widely  diffused.  It  would  be  an  almost  hopeless  task 
to  give  each  writer  credit  for  the  introduction  or  description  of 
particular  hydrotherapeutic  methods.  References  have  been 
made  in  places  throughout  this  work  so  that  further  studies 
may  be  made.  For  a  bibliography  one  is  referred  to  the  first 
and  second  series  of  the  Index  Catalogue  of  the  Surgeon-General's 
Library  at  Washington.     A  glance  at  this  remarkable  list  shows 


8  PREFACE 

at  once  the  great  hokl  that  hydrotherapy  has  in  medical  practice 
in  Germany,  Austria,  and  France.  It  is  to  be  hoped  that  in 
America  the  growing  practice  of  hydrotherapy  and  balneology 
may  be  guided  along  rational  lines,  and  we  believe  that  the  ])ro- 
fession  and  the  public  will  eventually  award  it  first  place  in 
physiologic  therapeutics. 

The  medical  profession  in  the  United  States  owes  a  debt  to 
Dr.  Simon  Baruch,  of  Columbia  University,  for  advancing 
greatly  the  practice  and  teaching  of  hydrotherapy,  and  the 
author  is  under  personal  obligations  to  him  for  many  sug- 
gestions. 

While  the  author  is  a  firm  believer  in  using  physiologic 
therapeutics  wherever  possible,  he  by  no  means  wishes  to  exclude 
the  use  of  drugs.  Rational  therapeutics  calls  for  their  use,  but 
reference  to  them  is  necessarily  omitted  here.  It  is  also  true 
that  many  diseases  are  amenable  to  hydrotherapeutic  treat- 
ment whose  names  are  not  mentioned,  but  the  underlying 
principles  are  stated,  and  it  remains  for  the  practitioner  to  apply 
them,  along  with  other  remedies,  for  the  improvement  of  the 
circulation,  for  enhancing  the  tone  of  the  skin,  for  an  effect 
upon  the  nervous  system,  or  in  any  other  way  that  moisture  or 
heat  or  cold  may  be  deemed  useful. 

In  treating  patients  at  spas,  and  especially  those  who  have 
been  sent  away  in  the  hope  of  completing  a  cure  begun  at  home, 
great  caution  should  be  exercised  in  order  to  preserve  harmony 
between  the  previous  medical  attendant  and  the  one  who  assumes 
temporary  charge  of  the  case.  Patients  generally  are  willing 
and  expect  to  relinquish  much  of  their  previous  internal  medica- 
tion. This,  however,  is  by  no  means  always  necessary.  In- 
deed, the  hydrotherapeutic  measures  adopted  are  often  aided  by 
medication,  and  it  requires  a  nice  estimate  of  their  value  in 
order  that  their  aid  should  not  be  lost.  This  is  most  true  in  all 
specific  cases,  and  here  medication  can  be  pushed  to  the  point 
of  greatest  efficacy.  Many  of  the  ordinary  drugs,  however, 
which  patients  bring  with  them  can  be  dispensed  with. 

A  favorable  mental  attitude  is  a  great  help  in  all  treatment; 


PREFACE 


9 


patients  who  have  traveled  far  for  their  cure  are  thereby  relieved 
of  most  of  the  harassing  features  of  their  previous  surroundings; 
they  are  impressionable  and  readily  give  themselves  up  to  a 
well-chosen  regime.  As  Dr.  Luke  says,  the  visitor  in  search 
of  health  cannot  do  better  than  lay  to  heart  the  old  Roman 
inscription  on  the  baths  of  Caracalla: 

"  Curae  vacuus  hunc  adeas  locum, 
Ut  morborum  vacuus  abire  queas; 
Hie  enim  non  curatur  qui  curat." 

"  Light  of  heart  approach  the  shrine  of  health, 
So  shalt  thou  leave  with  body  freed  from  pain; 
For  here's  no  cure  for  him  who's  full  of  care." 


Guy  Hinsdale. 


Hot  Springs,  Virginia, 
July,  1910. 


Bath.     The  Roman  baths, 


CONTENTS 


GENERAL  HYDROTHERAPY 

PAGE 

The  Rationale  of  Hydrotherapy 17 

The  Physiologic  Action  of  Saline  Baths  Compared  with  Fresh- 
water Baths 30 

The  Influence  op  Baths  on  Metabolism 33 

The  Effect  of  Cold  Baths  on  Metabolism 34 

Quantitative  Estimation  of  the  Amount  of  the  Heat  Loss.     Heat 

Regulation 41 

The  Effect  of  Hot  Baths  on  Metabolism  ; •.  .  .  .  45 

Tepid  or  Indifferent  Baths 48 

The  Effects  op  Baths  on  Blood-pressure 48 

The  Sphygmomanometer 49 

Counterindications  to  Baths 53 

Effects  of  the  Hot-air  Bath 54 

The  Effect  of  Baths  on  the  Rate  of  the  Heart 54 

The  Effect  of  Baths  on  the  Blood 56 

The  Effect  of  Cold  and  Heat  upon  Respiration 57 

SPECIAL  HYDROTHERAPY 

Typhoid  Fever 59 

The  Brand  Treatment 60 

Substitutes  for  the  Brand  Treatment 71 

Measles 79 

Scarlet  Fever 80 

Cholera 87 

Cerebrospinal  Meningitis 87 

Tetanus 89 

Insolation;  Sunstroke;    Heatstroke;  Thermic  Fever 90 

Tuberculosis 93 

Pneumonia 100 

Asphyxia  Neonatorum 108 

Acute  Bronchitis 108 

Acute  Congestion  of  the  Lung , 109 

Edema  of  the  Lung 110 

Influenza;  Epidemic  Catarrhal  Fever 110 

11 


12  CONTENTS 

PAGB 

Asthma 110 

Renal  Diseases Ill 

Sweating Ill 

Chronic  Interstitial  Nephritir; 114 

Toxemia  of  Pregnancy 117 

Urcniia 117 

Scarlatinal  Xephriti': 118 

Diabetes  Mellitus 118 

Diabetes  Insipidus 120 

Phosphaturia 120 

Rheumatism 120 

Chronic  Rheumatism 120 

Acute  Rheumatism 123 

Cerebral  Form  of  Rheumati.  ra 124 

Prophylaxis  of  Rheumatism 126 

Rheumatic  Phidocarditis 126 

Acute  Arthritic  Outbreaks 126 

GotT  (Arthritis  Urica) , 127 

Gonorrheal  Arthritis 130 

Arthritis  Deforjians 131 

Diseases  of  the   Heart 132 

Nauheim  Baths  and  Schott  Treatment 134 

Pericarditis,  Endocarditis,  and  Myocarditis 146 

Arteriosclerosis 147 

Toxemic  Myocarditis 148 

Chronic  Rheumatic  Myositis;  Lumbago 148 

Alcoholism;    Morphinism;    Chronic  Lead-,  Mercury-,  and  Arsenic- 
Poisoning,  AND  Tobacco  Habit 149 

Digestive  Disorders 150 

Constipation 151 

Gastroptosis 153 

Chronic  Gastritis  and  Enteritis 154 

Round  I'Icer  of  the  Stomach;  Hemorrhage 154 

Atony  and  Enteroptosis 156 

Ner\'ous  Dyspepsia 156 

Peristahic  Unrest 157 

Cholera  Infantum 157 

Peritonitis  and  Appendicitis 158 

Seasickness • 158 

Anemia;   Chlorosis;  Convalescence  from  Acute  Illness 158 

Anemia 158 

Chlorosis 160 

Vasomotor  Spasm  and  Visceral  Anemias 161 

Splenic  Enlargement 161 

Neurasthenia. 162 

Sexual  Neurasthenia 165 


CONTENTS  13 

PAGE 

Spermatorrhea 165 

Neuroses  of  the  Bladder 166 

Insomnia 166 

Insanity 168 

Melancholia 172 

Excited  States 173 

Epilepsy 178 

Headache 183 

The  Neuralgias 184 

Trifacial  and  Occipital  Neuralgia 184 

Sciatica 184 

Neuritis 186 

Paralysis 187 

Local  Palsies 187 

Paralysis  of  Adults 187 

Locomotor  Ataxia 188 

Paralysis  of  Central  Origrn 189 

Obesity 190 

Exophthalmic  Goiter 197 

Syphilis 197 

Skest  Diseases 203 

Psoriasis 204 

Leprosy 206 

Eczema 208 

Parasitic  Skin  Diseases . 208 

furunculosis  and  pemphigus 209 

Hydrotherapy  in  Surgical  Affections 209 

Diseases  of  the  Bones  and  Joints 211 

Sprains 211 

Felons,  Funmcles,  and  Phlegmons 214 

Surgical  Shock 214 

Football  Injuries 215 

Bums  and  Scalds 215 

Erysipelas  and  Ivy-poisoning 218 

Bed-sores 218 

Genito-urinary  Diseases 219 

Cystitis 219 

Orchitis,  Epididymitis,  and  Bubo 220 

Gynecologic  Affections 221 

Diseases  Amenable  to  Nauheim  Baths 221 

Sitz-baths 226 

Eye   Diseases .227 

External  Affections 227 

Internal  Ocular  Affections 227 

Induced  Phenomena  During  a  Course  of  Hydrotherapy 230 


14  CONTENTS 

TECHNIC  OF  HYDROTHERAPY 

PAGE 

The  Effects  of  External  Applications  of  Heat  and   Cold 233 

Baths 237 

The  Cooling  Wet  Sheet  Pack 237 

The  Evaporation  Bath 237 

The  Cold  Bath 238 

The  So-called  " Half-bath"  of  Priessnitz 243 

The  Spray  Bath 244 

The  Ablution  or  Wet  Mit  Friction 246 

The  Drip  Sheet  or  Sheet  Bath 246 

Sponging 248 

Rubs 249 

The  Oil  Rub 249 

The  Scotch  Rub 250 

The  Alcoliol  Rub . 251 

Douches 251 

The  Needle  Douche;  the  Needle  Spray;  the  Circular  Douche 251 

The  Cold  Douche 253 

Alternating  Hot  and  Cold  Douches 256 

The  Rain  Douche 258 

The  Fan  Douclie 261 

Tlie  Filiform  Douche 262 

The  Perineal  or  Ascending  Douche 262 

The  Aix  Douche;  the  Massage  Douche 263 

The  Viciiy  Douche 276 

The  Combined  Bath,  Douche,  and  Massage 276 

Tlie  Percussion  Douche 278 

The  Pail  Douche  or  Pail-pour 278 

The  Hot  Lumbar  Douche 280 

The  Fleury  Douche 280 

The  Control  Table 281 

Affusions 287 

Continuous  Baths 287 

The  Warm  Full  Bath 287 

Hot-water  Bathing 291 

The  Turkish  Bath  (Diaphoretic) 295 

The  Russian  Bath  (Diaphoretic) 301 

Vapor  or  Sweating  Bath 301 

The  Roman  Bath 304 

The  Hot-air  Bath  and  the  Electric-light  Bath 305 

The  Foot-bath 308 

Medicated  or  Modified  Baths 308 

Nauheim  Baths;  Carbonated   Baths;  Acid  Baths  (Kisch);  Effer- 
vescing liATHS 310 

Artificial  Nauheim  Baths 311 

The  Oxygen  Bath 323 

Mud  Baths  and  Fango  Packs 332 


CONTENTS  15 

PAGE 

Mud  and  Peat  Baths 334 

Sand  Baths 335 

The  Sitz-  or  Hip-bath 336 

Packs — Cold  Wet  Packs  (Fbuchte  Einpackung);  Hot  Wet  Packs; 

Dry  Packs  (Trockene  Einpackung) 338 

The  Cold  Wet  Pack 340 

The  Hot  Wet  Pack 341 

The  Dry  Hot  Pack 344 

Compresses 344 

The  Cold  Compress , 346 

Ice  Compresses 347 

Fomentations  or  Hot  Compresses 347 

Hot  and  Cold  to  the  Spine 354 

Salt  Rub  or  Salt  Glow 354' 

The  Ice  Rub  or  Ice  Ironing 355 

Cold  Applications  Under  the  Heart 355 

Neptune's  Girdle 356 

Swedish  Shampoo 359 

Rectal  and  Colonic  Rectal  Irrigation 359 

Proctoclysis 361 

The  Vaginal  Douche 370 

Public  Baths 372 

Shower-baths 375 

Sea-baths 377 

Courses  of  Instruction  in  Hydrotherapy 383 

Accidents  in  Hydrotherapy 386 

CROUNOTHERAPY,  CRENOLOGY,  OR  THE  USE  OF  MINERAL 
WATERS  INTERNALLY 

Classification  of  Mineral  Waters  . . . : 390 

Radio-activity  of  Mineral  Waters 390 

Internal  Use  of  Water  in  Health 395 

Hot-water  Draughts 395 

Cold-water  Draughts 396 

Distilled  Water 397 

Water  Drinking  in  Disease ; 400 

Specific  Value  of  Mineral  Water 403 

AlkaHne  Waters 403 

AlkaHne-cakareous  or  Earthy  Mineral  Waters 405 

Sahne  Waters;  Muriated  Sahne  Waters 406 

Sea  Water 411 

Use  of  Radio-active  Waters  Internally 412 

Bitter  or  Purgative  Waters 413 

Sulphur  Waters 413 

Chalybeate  Waters;  "Steel  Waters"  of  Europe 415 


16  CONTENTS 

PAGE 

Specific  Value  of  Mineral  Water — 

Sodic-bromo-iodin  Waters 416 

Lithia  Waters 417 

Water  as  an  Emetic 419 

PRESCRIPTIONS  OF  HYDROTHERAPY 

Abbreviations 421 

Prescriptions .^ 421 

Requisite  Equipment  for  an  Institution 431 

APPENDIX 

Some  Truths  About  Hydrotherapy _ 432 

Electric  Pad,  or  Thermophore 448 

Electric  Thermophore  Blanket 449 


INDEX 451 


HYDROTHERAPY 


GENERAL   HYDROTHERAPY 


THE  RATIONALE  OF  HYDROTHERAPY 

The  physical  and  chemic  qualities  of  the  water  used  in  hydro- 
therapy must  be  understood.  So,  also,  must  we  understand  the 
anatomy  and  physiology  of  the  skin,  the  nervous  system,  the 
heart,  and  circulation;  in  short,  the  remarkable  impress  which 
water  in  the  various  ways  in  which  it  is  apphed  makes  upon  every 
function  of  the  body.  This  agent  derives  its  varied  powers  from 
its  remarkable  flexibility  of  administration.  It  is  applied  as  a 
solid,  a  liquid,  and  as  a  vapor;  it  is  used  in  its  natural  state  either 
hot  or  cold,  pure  or  highly  mineralized;  free  from  gas  or  more  or 
less  charged  with  carbon  dioxid  or  sulphur  dioxid;  it  may  be 
applied  in  pools,  tubs,  jets,  or  sprays,  and  with  or  without  pres- 
sure ;  in  the  quiet  of  the  sick  room  or  in  the  boisterous  surf  of  the 
ocean.  This  capacity  for  infinite  gradation,  and  its  almost  un- 
bounded applicability  to  various  pathologic  states,  justifies  the 
claim,  made  with  growing  insistence,  that  the  use  of  water  com- 
mands the  first  place  in  modern  therapeutics. 

A  glance  at  the  list  of  hydrotherapy  references  in  the  cata- 
logue of  the  Surgeon-General's  Library,  Washington,  reveals  a 
most  voluminous  literature.  There  are  32  columns  and  640 
references  to  the  subject  of  hydrotherapy.  No  other  single 
remedial  measure  can  compare  with  it  in  its  antiquity;  no  other 
method  of  treatment  is  so  extensively  employed  in  the  modern 
world.     The  time  is  coming  when  this,  as  well  as  other  physical 

2  17 


18  HYDROTHERAPY 

measures,  will  be  utilized  not  alone  in  hospitals  and  sanitaria, 
but  will  become  the  common  proi)erty  of  general  practitioners. 

Physicians  now  realize  that  by  physiologic  therapeutics  much 
more  can  be  done  than  by  drugs;  patients,  also,  demand  from 
their  medical  advisere  definite  information  as  to  climates, 
resorts,  and  the  use  of  mineral  springs,  so  that  the  broader  the 
knowledge  of  these  subjects  by  personal  experience,  the  more 
valuable  and  more  highly  appreciated  is  the  advice  given. 
Resorts  having  a  good  climate  with  the  additional  advantage 
of  hydrotherapy  or  of  mineral  baths  are  numerous  in  Europe 
and  America. 

One  advantage  that  hydrotherapy  has  over  balneology,  or 
the  use  of  mineral  baths,  is  that  it  is  possible  to  install  complete 
hydrotherapeutic  apparatus  anywhere,  i)rovided  we  have  a  good 
water  supply  and  means  for  heating  and  cooling  the  water. 
On  the  other  hand,  mineral  springs,  as  employed  in  balneology, 
occur  where  nature  has  located  them.  Fortunately,  the  location 
of  most  of  these  resorts  is  very  attractive.  The  most  remark- 
able group  of  mineral  springs  in  the  United  States  is  found  in  the 
Yellowstone  National  Park,  a  wonderland  of  beauty  and  sub- 
limity. Undoubtedly  the  time  is  near  when  the  mineral  springs 
of  the  National  Park  will  be  utilized  for  balneologic  purposes. 

While  many  writers  draw  nice  distinctions  between  hydro- 
therapy and  balneolog}^,  the  author  fails  to  see  any  great  differ- 
ence, at  least  from  the  clinical  standpoint.  The  two  subjects 
are  indissolubly  connected;  their  effects  on  the  human  system 
are  governed  by  the  same  laws;  the  results  obtained  are  due  much 
more  to  the  physics  of  the  process  than  to  the  chemistry  of  the 
medium  employed. 

In  hydrotherapeutic  applications  the  chemic  analysis  of  the 
water,  as  regards  mineral  constituents,  is  a  negligible  quantity. 
The  water  is  used  as  a  means  for  conveying  heat  to  the  body  or 
abstracting  heat  from  it;  it  is  the  medium  by  which  force  or 
pressure  is  applied  to  the  various  parts  of  the  body ;  by  which  an 
impress  is  made  upon  the  circulation  or  other  physiologic  pro- 
cesses concerned  in  secretion  and  nutrition. 


THE   RATIONALE    OF   HYDROTHERAPY  19 

So  with  balneology.  From  time  immemorial  the  mineral 
springs  have  been  employed.  The  fame  of  Thermopylae  (Bspfial 
TCvXaC),  a  sulphur  spring  that  has  been  in  use  in  Greece  for  two 
thousand  years,  of  Hieropolis  and  Philadelphia  in  Asia  Minor, 
of  Helouan  in  Egypt,  Carlsbad,  Baden-Baden,  Aix-les-bains, 
Bath,  the  Aguee  Calientes  of  the  Spanish  American  possessions, 
the  Springs  of  Mt.  Clemens,  and  the  Hot  Springs  of  Virginia, 
North  Carolina,  and  Arkansas,  rests  upon  something  more  than 
the  chemic  nature  of  the  waters.  Two  thousand  years  of  implicit 
faith  in  laboratory  analyses  has  been  challenged  in  these  latter 
days  by  the  "higher  criticism"  of  the  German  and  Austrian 
leaders  in  the  field  of  modern  hydrotherapy.  Consider  for  a 
moment  the  well-founded  reputation  of  the  three  great  American 
resorts  for  the  successful  treatment  of  rheumatism,  and  the 
similarity  of  results  in  this  particular  affection,  and  then  compare 
the  chemic  analyses  of  the  waters,  and  see  the  enormous  difference 
between  these  springs  from  the  standpoint  of  chemic  contents. 

Boiler  Spring.     ^^^1|^°^gf.''''''  (Original  Spring). 

Hot  Springs,  Hot  Springs,  Mt.  Clemens, 

Virginia.  Arkansas.  Michigan. 

SiUca 4.50  2.58  27.60 

Potassium  chlorid 53 

Potassium  sulphate 68 

Sodium  chlorid 58  .27  11,900.00 

Sodium  sulphate 19  .41 

Sodium  sulphid 21 

Magnesium  chlorid ,  .  •  •  •  648.5 

Magnesiumi  bromid -  •  •  •  6.37 

Magnesium  carbonate 2.70  1.13  .70 

Magnesium  sulphate 6.04 

Calcium  chlorid •  •  •  •  934.5 

Calcium  carbonate 18.63  8.32  -98 

Calcium  sulphate 1.82  ....  100.50 

Cu.  in.  carbon  dioxid 24.60  4.71  5.80 

Cu.  m.  hydrogen  sulphid .10  11.92  40. 

Total  soUds 43.00  13,653.32 

The  table  shows  that  there  is  twenty  thousand  times  as  much 
sodium  chlorid  in  the  Mt.  Clemens  water  as  there  is  in  the  waters 
of  Virginia  Hot  Springs;  the  former  are  heavily  charged  with 
hydrogen  sulphid,  while  in  the  latter  the  gas  is  imperceptible, 
being  present  in  only  .1  cu.  in.  per  gallon.  The  Hot  Springs 
of  Arkansas  have  comparatively  little  mineral  content. 


20  HYDROTHERAPY 

Here,  then,  we  iiavc  three  mineral  springs,  widely  separated 
geographicalh',  and  varying  greatly  in  the  conii)osition  of  the 
mineral  contents,  yet  all  three  yielding  satisfactory  results  in  a 
given  disease,  e.  g.,  rheumatism. 

No  one  denies  that  there  is  a  difference  in  the  sensations  pro- 
duced by  bathing  in  fresh  water  and  in  salt  water;  or  between 
bathing  in  a  calcareous  water  and  in  a  brine  containing  from  1 
to  2  pounds  of  salt  to  the  gallon;  or  that,  in  bathing  in  water 
highly  mineralized  and  carbonated,  considerably  lower  tempera- 
tures should  be  employed  than  in  the  use  of  fresh  water  or  that 
which  is  very  lightly  mineralized.  This  principle  is  recognized 
in  the  administration  of  the  Nauheim  bath,  the  temperature  of 
which  is  usually  fixed  at  about  95°  F.  (35°  C),  but  any  other 
effect  than  that  on  the  peripheral  nerve  terminals,  and  thus  modi- 
fying the  response  of  the  nervous  system,  is  a -matter  which  has 
not  been  established. 

The  question  resolves  itself  into  a  single  proposition:  Are 
any  of  the  mineral  constituents  absorbed  through  the  skin  of  the 
bather  while  in  the  bath?  Popular  opinion  and  belief  are  strongly 
in  the  affirmative.  The  vested  interests  and  their  adherents  at 
the  various  spas  in  Europe  and  America  stoutly  maintain  that 
this  is  the  case,  and  immediately  ask  how  else  we  would  explain 
the  remarkable  cures  that  have  been  observed  during  centuries 
of  successful  experience. 

The  question  is  a  vital  one,  and  deserves  a  candid  and  un- 
biased consideration.  The  fact  that  cures  have  been  observed 
under  any  given  method  of  treatment  has  not  always  been  in- 
terpreted properly  respecting  the  means  employed.  Credit 
has  been  given  frequently  to  remedies,  and  particularly  to  drugs, 
that  have  in  nowise  aided  in  recovery.  This  has  been  the  case 
for  ages,  and  will  always  be  the  case  with  the  present  constitu- 
tion of  the  human  understanding. 

It  is  interesting  to  see  the  explanation  of  the  action  of  the 
waters  of  Bath,  England,  given  by  Dr.  Robert  Pierce,  who  prac- 
tised for  sixty  years  in  that  resort.     In  his  work  "History  and 


THE    RATIONALE    OF   HYDROTHERAPY  21 

Memoirs  of  the  Bath/'  published  in  1713,  he  records  a  case  of 
intermittent  Hmp  which  he  cured.     He  says : 

'Tor  it  brought  warmth  and  heat  into  the  part,  which  it  was 
altogether  destitute  of  before;  it  took  off  the  convulsive  motions 
which  were  before  frequent  and  violent  (especially  at  night  and 
when  he  was  first  falling  asleep.)" 

James  Currie,  who  wrote  one  of  the  first  and  best  books  on 
hydrotherapy,^  states  that  there  is  no  increase  of  weight  in  the 
bath,  and  while  the  skin  remains  "sound  and  entire  no  absorption 
of  solid,  liquid,  or  aeriform  elastic  fluid  takes  place  on  the  surface. 
In  the  instances  that  are  supposed  to  favor  the  contrary  opinion, 
it  will  be  found  that  the  article  is  forced  through  the  epidermis 
by  mechanical  pressure,  or  that  the  epidermis  has  been  pre- 
viously destroyed  by  injury  or  disease."  Currie  refers  to  the 
experiments  of  M.  Seguin,^  which  were  made  for  the  purpose  of 
determining  the  question  of  cutaneous  absorption.  "He  dis- 
solved in  the  water  of  the  bath,  in  which  he  made  his  experi- 
ments, substances  which  produce  a  specific  effect  when  received 
into  the  system,  by  which  their  inhalation  might  be  ascertained. 
He  employed  the  oxygenated  muriate  ot  mercury^  in  solution  on 
a  number  of  venereal  patients,  and,  while  the  epidermis  was 
entire,  he  never  perceived  a  single  instance  of  salivation  or  even 
of  amendment  of  their  complaints.  But  in  cases  where  a  con- 
siderable portion  of  epidermis  was  injured  or  destroyed,  as  in  the 
itch,  the  specific  effects  of  mercury  on  the  system  were  produced. 
The  experiments  of  M.  Seguin  are  very  numerous,  and  appear 
to  be  devised  so  as  to  meet  every  objection.*  He  concludes  from 
the  whole  that,  while  the  epidermis  is  entire,  the  absorbents  of 
the  surface  take  up  neither  water  nor  air,  nor  any  substance 
diffused  or  dissolved  in  either." 

1  Medical  Reports  on  the  Effects  of  Water,  Cold  and  Warm,  as  a  Remedy 
in  Fever  and  Other  Diseases,  second  ed.,  Liverpool,  1798,  p.  264. 

2  Fourcroy,  La  Medecine  eclairer  par  les  Sciences  physiques,  p.  232;  see 
also  Appendix,  No.  Ill,  Currie's  treatise. 

3  Bichlorid  of  mercury. 

*  He  also  used  solutions  of  antimony  and  potassium  tartrate,  muriate  of 
ammonia  and  mercury,  etc. 


22  HYDROTHERAPY 

The  explanation  afforded  by  Dr.  Pierce  two  hundred  years 
ago,  and  by  Currie,  in  the  same  century,  of  the  modu.^  operandi 
of  the  mineral  bath  met  with  vigorous  local  ojii^osition,  \yas  not 
generally  received,  but  it  is  fully  substantiated  by  the  modern 
school.  Professor  Heinrich  Kisch,  of  the  University  of  Prague 
and  of  j\Iarienbad,  has  formulated  his  views  in  a  recent  treatise 
on  Mineral  Waters  and  Their  Uses,*  as  follows : 

"That  circumstances  upon  which,  formerly,  a  particular 
emphasis  was  placed  in  estimating  the  value  of  mineral  baths — 
namely,  that  the  constituents  of  the  mineral  water  employed  for 
the  bath  were  capable  of  exerting  a  direct  influence  by  absorption 
into  the  blood — has  been  forced  into  the  background  by  recent 
investigation.  The  question  as  to  whether  the  uninjured  human 
skin  is  capable  of  absorbing  the  substances  dissolved  in  the  water 
of  the  bath  has  been  decided  in  the  negative  by  recent  thorough 
research.  The  results  of  earlier  studies,  apparently  showing  that 
increase  in  weight  occurs  after  the  bath,  and  that  this  is  due  to 
absorption  of  water,  that  the  increase  in  the  quantity  of  urine 
secreted  after  the  bath  is  a  result  of  the  absorption  of  water,  and, 
further,  that  after  simple  muriated  baths  there  is  an  increase  in 
the  urinary  chloritls,  indicating  a  diffusion  of  the  salt  of  the 
bath,  have  not  been  confirmed.  ...  It  is  true  that  substances 
capable  of  injuring  the  horny  layer  of  the  skin — as,  for  instance, 
mercuric  chlorid,  arsenic,  salicylic  acid,  salol — will,  when  added 
to  the  bath,  be  absorbed  through  the  skin,  and  this  appears  not 
unimportant  in  connection  with  certain  varieties  of  baths,  such 
as  peat-baths  and  mud-baths.  Ethereal  solutions,  also,  as  those 
of  atropin,  cocain,  lithium  chlorid,  veratrin  and  aconitin,  are, 
according  to  the  experiments  of  R.  A\'internitz,  absorbed  by  the 
skin.  On  the  other  hand,  Winternitz  found  it  impossible  to 
demonstrate  the  direct  entrance  of  these  substances  into  the 
skin  from  watery  solutions : 

"It  may,  therefore,  be  considered  as  established  that  the  un- 
injured human  skin  is  not  permeable  to  water  and  to  indifferent 

1  A  System  of  Physiologic  Therapeutics,  vol.  be,  edited  by  S.  Solis  Cohen, 
Philadelphia,  1902. 


THE   RATIONALE   OF   HYDROTHERAPY  23 

substances  dissolved  in  it,  even  after  long-continued  exposure, 
and  that  absorption  of  fixed  constituents  through  the  skin  does 
not  take  place  in  mineral  baths.  The  skin  of  the  bather  is  prob- 
ably, however,  permeable  by  the  gases  and  volatile  constituents 
of  the  mineral  water,  as  the  author  has  demonstrated  for  carbon 
dioxid,  and  Rohrig,  for  hydrogen  sulphid  and  illuminating  gas." 

Rohi'ig  made  some  experiments  as  to  whether  iodin  can  be 
absorbed  from  the  bath.  He  took  special  precautions  to  protect 
with  fat  the  mucous  membranes  exposed  in  the  bath,  and  respira- 
tion was  carried  on  through  a  tube  terminating  outside  the  room. 
Although  he  remained  for  three-ciuarters  of  an  hour  in  full 
baths,  to  which  potassium  iodicl  had  been  added,  and  that  were 
maintained  at  a  temperature  of  95°  F.  (35°  C),  no  iodin  ap- 
peared in  the  urine.  Kletzinsky,  Lehman,  Thomson,  Rabateau, 
Ritter,  and  others,  according  to  Kisch,  obtained  similar  negative 
results  in  experiments  with  baths  to  which  soluble  substances, 
such  as  potassium  ferrocyanid,  potassium  nitrate,  ferrous  sul- 
phate, and  ferrous  carbonate  were  added. 

Stas^  made  similar  observations  on  himself.  On  three  suc- 
cessive days  he  subjected  himself  to  baths  of  86°  to  90°  F.  (30° 
to  32.2°  C),  containing  50  mg.  of  sodium  arsenate  to  the  Hter. 
Though  immersed  for  prolonged  periods,  not  the  slightest  absorp- 
tion was  noted.  The  same  results  were  obtained  from  baths  of 
potassium  iodid  and  other  salts,  which  would  have  been  easily 
recognized  in  the  urine  had  they  been  absorbed. 

Dr.  Simon  Baruch,  who  has  given  this  subject  close  study  for 
forty  years,  and  has  pubhshed  an  elaborate  resume  of  the  litera- 
ture bearing  on  the  physiology  of  the  bath,  is  in  accord  with 
these  views,  and  in  his  comments  makes  it  clear  that  these  nega- 
tive results  do  not  militate  against  the  general  impression  that 
such  mineral  baths  are  exceedingly  useful  and  effective  thera- 
peutically, due  in  some  measure  to  climatic  and  hygienic  ele- 
ments beside  the  local  and  general  temperature  effects.  He 
clearly  states  that  the  heat  or  cold  conveyed  by  the  peripheral 
cutaneous  nerves  to  the  central  nervous  system,  and  thence  re- 
1  La  Presse  Medicale  Beige,  1886,  No.  13. 


24  HYDROTHERAPY 

fleeted  through  the  motor  tracts,  is  the  really  effective  element  in 
the  mineral  baths.  The  latter  are  aided  by  only  such  ingredients 
as  stimulate  the  cutaneous  nerves,  e.  g.,  strong  saline  or  carbonic 
acid  gas  constituents.  Other  mineral  ingredients  are  indifferent 
in  their  effect  upon  the  skin,  and  utterly  incapable  of  entering 
the  system  by  cutaneous  imbibition.  These  are  facts  substan- 
tiated by  exact  experimentation — facts  which  must  unsettle 
long-cherished  ideas,  and  arouse  a  healthy  skepticism  in  the 
minds  of  medical  men,  and  induce  them  to  trust  more  frequently 
to  the  thermic  and  mechanical  effect  of  pure  water,  i.  e.,  hydro- 
therapy. 

We  are  thus  forced  to  the  conclusion  previously  enunciated, 
that  hydrotherapy  and  balneolog}'^  go  hand  in  hand,  and  that 
the  mineral  waters,  the  analyses  of  which  are  quoted  with  such 
particular  exactitude  unto  the  third  or  fourth  decimal  place  of 
grains  per  gallon,  are  neither  more  nor  less  efficacious  on  that 
account. 

On  what,  then,  does  the  value  of  the  mineral  bath  depend? 
First  of  all,  it  is  cleansing,  the  more  so  as  it  approaches  an  al- 
kaline reaction  and  an  elevated  temperature.  The  secretion  of 
the  sweat  glands  and  the  epidermal  scales  are  removed,  and  this 
allows  a  more  intimate  contact  of  the  water  with  the  body. 

Second,  there  is  a  stimulating  effect  on  the  skin  produced 
by  the  chemicals  dissolved  in  the  water.  These  saline  or  gaseous 
constituents  affect  the  peripheral  nerves  by  tactile  irritation, 
and  thus  produce  effects  on  the  circulatory  and  nervous  system 
in  a  reflex  manner.  This  is  probably  more  definite  when  the 
irritation  is  produced  by  such  gaseous  contents  as  carbon  dioxid. 
Next  in  order  would  be  the  action  of  the  denser  saline  waters, 
and  least  of  all,  that  of  the  mild,  calcareous  alkaline  waters. 

Third,  the  irritation,  which,  it  must  be  borne  in  mind,  means 
the  effect  of  cold  as  well  as  of  heat.  This  is  by  far  the  most  im- 
portant. It  is  obvious  that  the  greater  the  departure  from 
the  normal  temperature  of  the  body,  so  much  greater  will  be  the 
thermic  irritation  of  the  medium  used.  The  effects  of  heat  and 
cold,  as  applied  in  baths,  are  very  different.     On  applying  heat 


THE    RATIONALE    OF   HYDROTHERAPY  25 

or  cold  to  the  skin  there  is  a  direct  influence  on  the  part,  but  in- 
directly and  reflexly  through  the  central  nervous  system  there 
are  far-reaching  effects  upon  the  circulation  in  distant  parts. 
These  reflex  actions  are  of  great  importance  therapeutically, 
and  will  be  discussed  in  subsequent  pages  in  connection  with  par- 
ticular diseases  and  special  forms  of  treatment. 

In  applying  heat  or  cold  proximally, — i.  e.,  between  affected 
part  and  the  heart — we  attempt  to  control  the  circulation  in  the 
part,  but  to  avoid  the  use  of  direct  applications.  We  may  in- 
fluence the  circulation  in  an  injured  hand  by  applying  an  ice-bag 
in  the  axilla  or  at  the  bend  of  the  elbow,  or  we  may  apply  cold 
compresses  to  the  neck  to  contract  the  carotids  and  relieve  a 
congestion  of  the  brain.  So,  also,  we  may  use  heat  derivatively 
by  drawing  blood  away  from  the  affected  part.  The  hot  foot- 
bath and  leg-bath  are  familiar  examples. 

Fourth,  the  mechanical  irritation  occasioned  by  mud-baths, 
moor-baths,  and  any  motion  or  pressure  imparted  to  the  mineral 
water  in  its  application.  If  the  water  under  pressure  is  dis- 
tributed over  the  body  of  the  patient  in  fine  spray,  it  is  quite 
possible  that  some  of  the  contained  minerals  or  gases  may  reach 
the  interior  of  the  body  by  inhalation.  While  the  chemicals 
so  absorbed  would  certainly  be  infinitesimal,  the  gaseous  emana- 
tions from  the  mineral  water  may  have  a  more  appreciable  in- 
fluence. 

Heat  and  cold  are  two  conditions  of  the  same  force,  caloric, 
and,  with  reference  to  the  human  body,  mean,  respectively, 
the  intensity  of  caloric  above  and  below  98.4°  F.  (37°  C.)  O^ood). 
Dry  heat,  when  locally  applied  to  the  absolutely  dry  surface, 
may  be  borne  as  high  as  340°  F.  (171.1°  C);  in  local  applications 
it  may  be  borne  higher  in  the  form  of  radiant  heat,  but  the  pres- 
ence of  the  slightest  moisture  or  oily  application  quickly  results 
in  a  blister  or  burn  at  this  or  lower  temperatures. 

It  is  weU  recognized  that  a  certain  tolerance  is  established 
during  successive  applications,  and  this  holds  true  for  heat  as 
well  as  cold.  The  healthy  body  may  absorb  heat  to  the  extent 
of  3  or  4  degrees  or  more  if  confined  to  special  localities. 


26  HYDROTHERAPY 

In  order  to  preserve  a  constant  body  temperature,  whether 
exposed  to  heat  or  cold,  all  warm-blooded  animals  have  two 
inherent  faculties:  One,  a  physical  regulation,  causing  increased 
or  diminished  heat  loss;  the  other,  a  change  in  metabolism  which 
can  increase  the  heat  production  or  chemic  regulation.  These 
are  independent  of  the  protection  afforded  by  clothing.* 

Physical  regulation  is  controlled  by  processes  in  the  skin, 
where  cold  produces  contraction  and  a  bloodless  state.  This 
contraction  checks  loss  of  heat  by  radiation,  conduction,  and 
water  evaporation.  The  primary  hyperemia,  due  to  long-con- 
tinued cold,  is  scarcely  ever  seen  in  actual  practice.  The  second- 
ary hyperemia,  however,  which  follows  the  withdrawal  of  ice 
or  cold,  is  well  known,  and  when  artificially  obtained  is  termed 
in  hydrotherapy  the  "reaction."  Its  appearance  means  in- 
creased heat  loss  and  marks  the  end  of  the  control  by  physical 
regulation. 

In  order  to  enhance  the  reaction  in  hydrotherapy  the  physical 
regulation  may  be  prematurely  interrupted  by  the  application  of 
cold  after  heat,  by  employing  friction  in  the  bath,  and  by  using 
stimulating  chemic  substances,  such  as  carbonic  acid  gas,  various 
chlorids,  etc.,  in  the  water.  Great  stress  is  always  to  be  laid  on  a 
"reaction,"  and  when  baths  differ  much  from  the  normal  body 
temperature,  it  is  highly  necessary  to  secure  it.  The  appear- 
ance of  the  reaction  is  not  usually  as  well  marked  at  the  begin- 
ning of  a  course  of  bathing  as  in  the  subsequent  baths,  for  the 
reaction  can  be  cultivated  or  brought  out  as  the  skin  is  trained 
to  react. 

The  reaction  of  the  body  occurs  in  consequence  of  both 
cold  and  heat,  and  it  is  this  physiologic  feature  which  determines 
the  effect  of  hydrotherapeutic  treatment.  Both  air  and  water 
may  be  used  in  this  connection,  but  w^ater  is  generally  preferred 
because  it  has  a  greater  specific  heat  and  a  greater  coefficient 
of  heat  conducti\'ity.  Man  is  particularly  susceptible  to  hydro- 
therapeutic  effects.     There  is  no  natural  protection,  and  the 

^  See  Von  Noorden,  Metabolism  and  Practical  Medicine,  vol.  iii,  for  a  full 
discussion  of  this  subject. 


THE    RATIONALE    OF    HYDROTHERAPY  27 

clothing  which  he  wears  makes  him  sensitive  to  temperature 
changes.  In  order  to  estimate  in  advance  one's  reactive  capacity 
we  must  form  a  judgment  of  the  sensitiveness  of  the  body  sur- 
face. Clothing  forms  a  kind  of  habitual  thermal  zone  about 
the  body,  the  temperatiu-e  of  which  has  been  shown  by  Winter- 
nitz  to  remain  fairly  constant  at  about  89.6°  F.  (30°  C.).^ 

It  therefore  follows  that  an  ordinary  bath  must  have  a 
temperature  of  some  degi'ees  above  or  below  89.6°  F.  (30°  C.) 
in  order  that  a  decided  reaction  may  be  obtained.  A  tepid 
bath,  however,  as  low  as  85°  F.  (29.5°  C.)  or  as  high  as  95°  F. 
(35°  C.)  may  be  followed  by  a  reaction,  provided  we  employ 
at  the  same  time  some  mechanical  stimulation,  as,  for  ex- 
ample, by  means  of  a  douche  or  jet  having  some  force  of 
impact. 

A  healthy  man  plunging  into  cold  water  shivers  and,  after 
an  involuntary  pause  in  breathing,  inspires  very  deeply.  The 
skin  becomes  pallid,  owing  to  the  contraction  of  the  unstriped 
muscle-fibers,  and  he  may  or  may  not  show  the  phenomenon 
of  ''gooseflesh'^  or  cutis  anserina.  The  reaction,  as  we  nearly 
all  of  us  know  by  personal  experience,  may  set  in  while  one 
remains  in  the  bath  or  as  one  comes  out  of  it.  This  reaction 
is  the  common  experience  of  sea-bathing,  and  is  a  sine  qua  non 
if  it  may  be  indulged  in  with  safety. 

The  rapidity  and  degree  of  reaction  for  cold  varies  very  much 
in  different  individuals.  It  is  delayed  in  the  weak  and  feeble, 
but  develops  early  and  rapidly  in  the  robust,  especially  if  they 
have  been  in  the  habit  of  taking  cold  baths  (Weber). 

That  great  generalizer  in  hydrotherapy,  Prof.  Winternitz, 
has  formulated  some  of  the  principles  regarding  the  reaction, 
which  we  may  summarize  as  follows : 

The  secondary  warming  of  the  body  is  the  surest  sign  and 
most  marked  sjrmptom  of  reaction.  This  is  recognized  especially 
in  alterations  of  innervation,  circulation,  and  metabolism,  de- 
pending on  various  factors. 

1  See  Sir  Hermann  Weber  and  F.  Parkes  Weber,  Climatotherapy  and  Balneo- 
therapy, London,  1907,  p.  305.     ■ 


28  HYDROTHERAPY 

1.  The  absolute  amount  of  heat  loss.  The  reaction  is  greater, 
within  moderate  bounds,  the  lower  the  temperature;  the  greater 
the  fall,  so  much  greater  will  be  the  temperature  of  the  re- 
action. 

2.  The  more  quickly  the  loss  of  heat  occurs,  so  much  the 
more  quickly  will  the  secondary  increase  of  temperature  take 
place. 

3.  The  duration  of  the  cooHng  procedure  influences  the 
secondary  heat  production.  Long-continued  and  gradual  heat 
abstraction  is  followed  by  a  slow  reactive  temperature  increase 
of  moderate  intensity;  but  short  and  colder  water  applications, 
while  not  abstracting  so  much  heat,  are  yet  followed  by  a  good 
reactive  increase  of  temperature. 

The  best  reactions  with  the  least  loss  of  heat  are  generally 
obtained  by  cold  applications  of  short  duration,  administered 
when  the  patient  is  hot  (Weber). 

4.  The  degree  of  body  heat  before  the  application  of  cold 
influences  the  reactive  temperature  increase.  If  the  body  is 
very  warm,  at  first  it  reacts  more  strongly  to  cold. 

/  5.  A  warm  application  previous  to  the  cooling  procedure  in- 
creases the  intensity  of  the  reaction  according  to  the  individual's 
susceptibility  to  a  stimulus. 

6.  A  combination  of  cold  with  mechanical  stimuli  increases 
the  reaction. 

7.  Whether  the  reaction  is  prompt  or  not  depends  more  or 
less  on  what  the  subject  does  after  the  abstraction  of  heat. 
Rest  retards,  work  and  exercise  heighten,  the  reaction. 

8.  The  internal  use  of  stimulants,  especially  alcohol,  after 
the  abstraction  of  heat  promotes  the  reaction. 

9.  In  general,  the  reaction,  and  the  heat  production  as  well, 
bear  a  direct  relation  to  the  thermic  stimulus  to  the  nerves.  The 
stronger  it  is,  the  more  intense  is  the  result. 

Excessively  cokl  procedures  can  lead  to  a  delayed  and  ex- 
treme or  imperfect  reaction.  Febrile  cases  sometimes  show  this 
in  the  form  of  clamminess  of  the  skin  and  in  collapse.  Such  cases 
call  for  powerful  mechanical  stimuli.     The  organism  usually 


THE    RATIONALE    OF    HYDROTHERAPY  29 

reacts  to  thermic  and  mechanical  stimuli,  when  applied  in 
proper  dosage,  toward  either  excitation  or  depression/ 

Dr.  Simon  Baruch,  to  whom  we  are  greatly  indebted  for 
presenting  hydrotherapy  to  the  profession  in  an  ardent  and 
rational  manner,  has  reconstructed  the  entire  theory  of  reaction, 
and  proved  that  the  contention  between  Matthes  and  Winter- 
nitz  regarding  tonic  reaction  after  cold  was  baseless,  because 
their  premise  that  the  arteries  of  the  skin  contract  under  cold 
is  false.  If  this  were  true,  Matthes  would  be  right  that  there 
can  be  no  tonic  dilatation  of  the  arterial  muscular  coat — dilata- 
tion of  arteries  always  is  atonic,  of  course.  Dr.  Baruch  has 
shown  that  the  hyperemia  after  cold  is  due  to  filling,  not  of  the 
arteries,  which  are  too  deep,  but  of  the  capillaries  (arterial), 
after  having  been  emptied  by  the  constriction  of  the  unstriped 
muscular  fibers  which  abound  in  the  skin — that  the  sudden 
narrowing  of  the  peripheral  capillaries  by  this  muscular  con- 
traction, together  with  the  vasomotor  stimulus,  produces  an 
enhancement  of  the  ventricular  contraction  which  drives  ar- 
terial blood  in  abundance  to  the  arterial  capillaries  which  had 
been  previously  more  or  less  emptied  by  the  muscular  constric- 
tion to  which  the  cold  has  subjected  them.  This  warm  afflux, 
slowly  or  rapidly,  according  to  previous  duration  and  intensity, 
removes  the  constriction,  and  thus  the  capillaries  are  permitted 
to  fill  as  the  barrier  is  removed ;  the  ventricular  activity  continu- 
ing, forces  more  and  more  blood  into  these  capillaries,  which, 
having  no  muscular  coats,  dilate  as  far  as  the  normal  contractility 
of  the  cutaneous  muscular  structures  admit.  The  latter  con- 
tinues to  offer  a  barrier  to  further  distention,  and  in  this  wise 
is  the  tone  at  the  periphery  maintained — tonic  reaction. 

Dr.  Baruch  has  explained  the  atonic  dilatation  after  warm 
procedures  by  the  same  anatomic  and  physiologic  facts.  Here 
there  is  little  if  any  primary  vasomotor  action.  The  warm  bath 
relaxes  the  cutaneous  muscular  structure ;  the  skin  looks  sodden 
and  cyanotic  as  an  evidence  of  this  relaxation.     The  capillaries 

1  This  subject  is  thoroughly  treated  by  Prof.  W.  Winternitz  in  his  Physio- 
logische  Grundlagen  der  Hydro-  und  Thermotherapie,  Stuttgart,  1906. 


30  HYDROTHERAPY 

dilate  because  there  is  diminished  resistance ;  the  latter  weakens 
the  cardiac  action;  the  heart  compensates  by  increase  of  the 
number  of  contractions  for  the  imperfection  of  its  systole ;  the 
local  as  well  as  the  general  circulation  becomes  enfeebled; 
there  ensues  diminished  arterial  tension,  compressible  pulse,  etc. 
— we  have  atonic  congestion.  Hence  the  judicious  cold  bath  is 
tonic  or  stimulating,  while  the  judicious  warm  bath  is  atonic 
and  sedative,  demonstrating  the  flexibility  of  water  as  a  remedial 
agent.' 

Cheniic  regulation  has  an  equally  valuable  influence  in  phys- 
iology. It  depends  largely  on  the  state  of  nutrition,  the  type 
of  diet,  and  the  size  of  the  individual.  It  is  interesting  to  note 
that  chemic  regulation  is  always  accompanied  or  called  forth  by 
muscular  activity.  If  one  exercise  the  will  sufficiently  to  avoid 
shivering  or  any  other  movement,  then  physical  regulation  alone 
is  manifested.  This  subject  expands  rapidly,  and  the  reader  is 
referred  to  von  Noorden's  monograph  and  the  work  of  Speck 
and  others.^     (See  also  pp.  37,  38  for  a  further  discussion.) 

PHYSIOLOGIC    ACTION    OF    SALINE    BATHS    COM- 
PARED WITH   FRESH-WATER  BATHS 

Starting  with  the  assumption  that  possibly  saline  baths  exert 
a  different  action  on  the  organism.  Dr.  Theodore  Groedel  II 
made  a  great  number  of  experiments  bearing  on  this  matter 
under  the  direction  of  Professor  Rieder  in  the  Centralbad  of 
the  Munich  Clinical  Institute.^ 

Experiments  were  made  on  the  respiration,  pulse,  blood- 
pressure,  and  body  temperature  in  fresh  water  as  well  as  with 
baths  containing  sodium  chlorid,  potassium  chlorid,  and  calcium 
chlorid  of  known  concentration.  The  subjects  were  yoimg  men 
of  twenty  to  twenty-four  years,  who  were  placed  for  half  an  hour 
in  the  same  attitude,  in  an  empty  tub,  as  in  the  subsequent  bath. 
They  were  covered  with  a  sheet  and  the  necessary  instruments 

1  Personal  communication  to  the  author. 

2  Speck,  Die  Physiologie  der  Atmung,  1892,  p.  173. 

'  Berliner  klinischer  Wochenschrift,  March  13,  1905.  • 


ACTION    OF    SALINE    COMPARED    WITH   FRESH-WATER   BATHS     31 

were  in  place.  Just  before  the  beginning  of  the  bath  careful 
observations  were  made.  The  temperature  was  taken  in  the 
mouth;  the  blood-pressure  was  taken  with  the  Riva-Rocci 
sphygmomanometer;  two  competent  observers  were  assigned  to 
note  the  disappearance  and  reappearance  of  the  pulse,  so  as  to 
eliminate  any  personal  factor.  The  rate  of  the  pulse  was  recorded 
through  a  minute,  and  the  respiration  noted  by  a  water  mano- 
meter, provided  with  a  thin  rubber  tambour  attached  to  the 
breast  by  a  bandage.  The  tubs  were  then  filled  without  any  dis- 
turbance of  the  subjects,  and  measurements  were  taken  for  five 
minutes  and  repeated  in  five  minutes.  The  apparatus  remained 
unchanged  in  position  during  the  entire  period  of  the  experi- 
ments, so  that  the  readings  were  made  under  similar  conditions. 

The  baths  were  previously  arranged  so  that  they  consisted 
of  pure  fresh  water,  salt  water  in  strength  of  3,  4,  5,  6,  7,  8,  9, 
and  10  per  cent.,  potassium  chlorid  4  and  8  per  cent.,  and  calcium 
chlorid  4  and  8  per  cent.  The  atmospheric  temperature  of  the 
bath-rooms  was  maintained  at  20°  C.  (68°  F.),  that  of  the  baths 
at  35°  C.  (95°  F.),  which  is  an  accepted  standard  for  the  in- 
different bath. 

A  slight  loss  of  temperature  of  the  water  of  the  bath  was  noted ; 
without  the  subject  in  the  bath  it  amounted  in  fifteen  minutes 
to  about  .4°  C.  (.7°  F.) ;  with  the  subject,  it  varied  between  .3°  C. 
(.5°  F.)  and  .5°  C.  (.9°  F.).  The  body  temperature  fell  in  the 
fresh  water  between  .1  °  C.  (.18°  F.)  and  .2°  C.  (.4°  F.),  and  in  the 
salt  baths  to  .3°  C.  (.5°  F.).  The  respiration  record  gave  a 
variation  of  — 1  and  +1  in  the  fresh  water  and  — 4  and  +4  in 
the  salt  baths.  The  rate  of  the  pulse  was  not,  on  the  whole, 
affected  when  the  salt  baths  were  compared  with  the  fresh- 
water baths;  the  extreme  changes  noted  in  the  salt  baths  were 
+  4  and  — 8.  The  hlood-pressure  was  altered  from  0  to  -t-3  mm. 
Hg.  in  the  fresh- water  baths  and  from  — 10  to  + 19  in  the  salt 
baths,  the  higher  readings  being  obtained  with  the  10  per  cent, 
sodium  chlorid  and  the  calcium  chlorid  baths.  It  was  evident 
from  these  careful  observations  that  the  body  temperature,  the 
frequency  of  the  pulse,  and   respiration  were  practically  the 


32 


HYDROTHERAPY 


same  in  the  fresh-water  as  in  the  saline  baths;  while  in  the 
latter  the  blood-pressure  was  both  increased  and  diminished. 
Robin  found  that  nitrogen  elimination  was  increased  by  salt 
baths,  while  Keller  found  it  to  be  diminished. 

In  the  case  of  the  Turkish  bath  exposure  of  the  same  man  to  a 
temperature  of  122°  F.  (50°  C.)  for  fifty  minutes  in  the  drier 
air  raised  the  axillary  temperature  only  1.2°  F.,  the  pulse  32 


A 

/ 

\ 

llfi 

\ 

p. 

iz 

JOif 

7Z 

R. 

15 

18 

15 

a. 

b 

c 

Temperature  Effect  of  Turkish  Bath 
The  continuous  line  represents  temperature  in  the 
axilla.    The  dotted  line,  temperature  in  the  rectum. 

Day  before  batli.  Day  of  bath. 

Quantity  of  urine 15G7  cc.  950  cc. 

Specific  gravity  of  urine.    1018.8  1027 

Urea 45.47  gm.  39.90  gm. 

Uric  acid .683  gm.  .860  gm. 


Fig.  1. — Turkish  bath,  temperature  122°  F.  (50°  C):  a,  Body  temperature 
before  entering  the  bath;  b,  temperature  fifty  minutes  after  entering  the  batli; 
c,  temperature  twenty  minutes  after  leaving  the  batla  when  in  the  cooling  chamber; 
P,  pulse;  R,  respiration. 

beats,  and  the  respiration  only  from  15  to  18  per  minute.  The 
rectal  temperature  was  not  altered.  There  were  less  marked 
changes  in  the  quantity  and  density  of  the  urine;  the  increase  of 
uric  acid  excretion  was  about  the  same. 

Frey  and  Heiligenthals  made  careful  experiments  on  a  healthy 
man  exposed  for  twenty-five  minutes  to  the  saturated  air  in  a 
Russian  bath.     The  temperature  was  maintained  at  113°  F. 


INFLUENCE    OF   BATHS   ON   METABOLISM 


33 


(45°  C.)  and  the  following  changes  were  noted:  The  body- 
temperature  was  raised  from  98.4°  F.  (36.9°  C.)  to  103.4°  F. 
(39.6°  C);  the  pulse  rose  from  72  to  136;  the  respirations,  from 
17  to  23.  The  urine,  which  for  three  days  before  the  bath  had 
averaged  daily  1683  cc.  of  specific  gravity  1021,  was  reduced 


Temperature  Effect  of  Russian  Bath 
TJie  continuous  line  represents  temperature 

in  the  axilla.     The  dotted  line,  temperature  in 

the  rectum. 

Day  before  bath.     Day  of  bath. 

Quantity  of  urine 1683  cc.  900  cc. 

Specific  gravity  of  urine  1021  1027 

Urea 52.68  gm.      38.7  gm. 

Uric  acid .858  gm.        .980  gm. 


103 
102. 
»0I 
100 

*?8 

, 

A 

1 1 

J  / 

V 

\ 

r. 

7Z 

136 

70 

-R 

lY 

23 

17 

a 

b 

c 

Fig.  2. — Russian  bath,  temperature  113°  F.  (45°  C):  a,  Body  temperature 
before  entering  the  bath;  h,  temperature  twenty-five  minutes  after  entering  the 
bath;  c,  temperature  ten  minutes  after  leaving  the  bath;  P,  pulse;  R,  respiration. 

in  quantity  to  900  cc.  on  the  day  of  the  bath  and  had  a  specific 
gravity  of  1027.  The  urea  was  diminished  by  one-quarter  and 
the  excretion  of  uric  acid  rose  14  per  cent.^ 


INFLUENCE  OF  BATHS  ON  METABOLISM 

This  is  a  most  complex  and  little-understood  subject,  but  it 
is  generally  appealed  to  in  explaining  the  good  results  obtained 
by  hjdrotherapy.  Physiologic  chemistry  has  now  reached  a 
stage  of  development  far  beyond  the  comprehension  of  all  except 

1  See  Stevenson  and  Murphy,  Hygiene,  Article  by  Hale  White,  vol.  i,  p.  641. 
3 


34  HYDROTHERAPY 

special  students  and  laboratory  experts.  It  remained  for  von 
Noorden  to  undertake  the  heroic  task  of  coordinating  the  im- 
mense mass  of  literature  on  this  subject  accumulated  during  the 
last  ten  or  twelve  years.  In  his  third  volume,  written  in  con- 
junction with  Dr.  Carl  Dapper  and  Dr.  Max  Matthes,  he  has 
presented  some  of  the  more  recent  scientific  work,  referring, 
meanwhile,  to  the  "enormous  output  of  worthless  pscudoscien- 
tific  writings  which  mislead  the  inexpert.  A  clamorous  jargon 
has  been  invented,  which  includes  apparently  learned  expres- 
sions about  delayed  or  increased  metabolism,  oxidation,  assimila- 
tion, protein  balance,  molecular  disintegration,  ions,  osmosis, 
radio-activity,  and  the  like."' 

EFFECT  OF  COLD  BATHS  ON  METABOLISM 

Tissue  changes  brought  about  by  cold  baths  are  caused  by 
an  effect  on  the  innervation  of  the  muscles;  in  fact,  all  combus- 
tion processes  in  the  body  are  referable  to  the  muscles.  A 
simple  hot-air  bath  may  have  little  effect,  but  a  series  of  hot-air 
or  hot- water  baths  increases  nitrogen  elimination,  urea  elimina- 
tion keeping  pace  with  the  excretion  of  nitrogen,  and  uric  acid  is 
also  excreted  in  greater  quantity.  , 

Elaborate  studies  of  these  metabolic  changes  have  been 
made  by  many  observers  and  in  connection  with  ordinary 
hydriatric  procedures,  the  half-bath,  the  Scotch  douche,  etc. 
It  is  interesting  to  note  that  Hippocrates-  states  that  the  tem- 
perature elevation  which  occurs  in  connection  with  most  acute 
infectious  diseases  is,  within  limits,  remedial  in  purjDOse  and 
effect.  It  apparently  follows  that  temperature-elevating  baths 
may  be  beneficial  in  aiding  resistance  to  infection,  especially 
when  followed  by  a  short  cold  bath,  by  favoring  the  production 
of  alexins  and  antitoxins.  It  seems  to  us,  however,  that  cold 
baths  are  better,  practically,  in  the  infectious  fevers — witness 

1  Max  Matthes,  of  Cologne,  has  contributed  an  excellent  review  of  this 
subject  with  114  modem  references  to  European  literature  in  von  Noorden's 
Metabolism  and  Practical  Medicine,  vol.  iii,  chaps,  viii,  ix,  London,  1907. 

-  System  of  Physiologic  Therapeutics,  edited  by  S.  Solis  Cohen,  vol.  ix, 
p.  250. 


EFFECT  OF   COLD   BATHS   ON  METABOLISM  35 

the  brilliant  results  obtained  by  the  Brand  treatment  of  typhoid 
fever. 

That  baths  of  such  obviously  different  character  may  lead 
to  very  nearly  the  same  physiologic  result  is  one  of  the  seeming 
paradoxes  of  hydrotherapy.  This  is  recognized  in  practice,  for,  if 
patients  do  not  react  well  to  the  cold  bath  in  typhoid,  it  is  Dr. 
Wilson's  practice  at  the  Jefferson  Hospital  in  Philadelphia  to  give 
them  a  bath  at  110°  or  112° F.  (43.3°  or  44.4° C).  A  patient 
convalescent  from  long  illness  complained  to  Dr.  Sidney  Ringer 
that  he  feared  he  could  not  resume  his  usual  cold  morning  bath. 
"Never  mind,"  said  he,  "take  a  hot  one."  He  did  so,  having 
the  water  very  hot  and  remaining  in  the  bath  only  a  short  time. 
This  procedure  he  carried  out  every  morning  for  several  years 
after  the  illness.  The  stimulating  effect  was  produced,  whether 
the  baths  were  hot  or  cold. 

Dr.  Simon  Baruch  explains  this  seeming  paradox  by  the 
physiologic  fact  that  both  heat  and  cold  are  thermic  irritants 
which,  briefly  applied,  excite  the  peripheral  sensory  terminals 
and  thus  stimulate.  The  secondary  effects  differ  decidedly  if 
the-  application  be  prolonged. 

The  effect  of  the  Naicheim  hath  on  metabolism  would  naturally 
be  expected  to  be  most  pronounced,  consisting,  as  it  does,  of 
solid  and  gaseous  elements  in  large  quantities.  Improved 
assimilation  and  tissue  metabolism  is  evidenced  by  formation 
of  fresh  muscular  substance.  The  area  of  the  dilated  heart  is 
diminished,  but  its  power  and  true  volume  are  enhanced.  Super- 
fluous fatty  tissue  and  inflammatory  residual  products  disappear; 
effete  products  are  eliminated,  and  a  loss  of  weight  is  commonly 
noted  at  the  outset ;  but  more  substantial  evidences  of  construc- 
tive metabolism  begin  to  be  noted,  and  continue  long  after  the 
patient  ceases  to  take  the  course  of  treatment  provided  in  ac- 
cordance with  this  system  of  hydrotherapy. 

Dr.  Paul  Franze,  of  Bad  Nauheim,^  corroborates  many  other 

^  The  Physiologic  Action  of  the  Nauheim  Springs  and  the  Indications  for 
their  Use  in  Circulatory  Disorders,  Jour,  of  Balneology  and  Climatology,  July, 
1904 


36  HYDROTHERAPY 

observers  in  this  particular.  He  says:  "Tissue  metabolism  is 
accelerated  as  in  cold  fresh-water  baths,  only  more  pronounced, 
and  it  is  relevant  to  mention  that  researches  as  to  the  physiologic 
action  of  chalybeate  baths,  rich  in  carbonic  acid,  show  that  this 
gas  chiefly  promotes  the  metabolism  of  non-nitrogenous  matter, 
while  excreted  urea  is  diminished  relatively  to  its  intake.  Prac- 
tically, this  means  that  while  our  baths  reduce  superfluous  fatty 
tissue,  they  facilitate  the  formation  of  healthy  muscular  sub- 
stance. This,  of  course,  is  especially  applicable  to  the  efferves- 
cing Sprudel  baths.  The  acceleration  in  tissue  metabolism, 
aided  as  it  probably  is  by  osmosis,  promotes  the  absorption  of 
exudations  in  the  joints  and  pelvic  and  serous  cavities.  Nau- 
heim  baths  are  among  the  most  efficient  means  of  abolishing  the 
residues  of  rheumatism  and  gout,  of  serous  inflammations,  such 
as  pleurisy  and  pericarditis,  and  of  inflammatory  conditions  of 
the  adnexa  of  the  female  genital  organs." 

Turkish  baths  tend  toward  a  gain  in  weight,  but  if  the  heating 
process  is  shortened,  and  cold  water  is  applied  liberally  in  con- 
nection with  the  plunge,  the  subject  loses,  because  the  loss  of 
heat  has  to  be  made  good  by  increased  catabolism  in  the  tissues. 

The  latest  American  studies  of  the  effects  of  such  measures 
on  metabolism,  as  shown  by  an  analysis  of  the  urine,  are  those 
by  Dr.  Otto  Folin  and  Dr.  George  T.  Tuttle,  of  Waverly,  ]\Iassa- 
chusetts.* 

Nine  subjects,  including  mental  patients  of  good  physique 
and  nurses  in  the  McLean  Asylum,  at  "Waverly,  were  given  a 
uniform  diet  adapted  to  the  capacity  of  the  individual,  contain- 
ing a  known  amount  of  nitrogen.  After  this  diet  had  been  con- 
tinued for  two  days  the  urine  was  collected  for  each  twenty-four 
hours  and  subjected  to  an  exceedingly  careful  analysis.  After 
thi-ee  or  four  days  baths  were  given  about  as  follows  ■?  Hot-air 
cabinet.  174°  to  190°  F.  (78.9°  to  87.8°  C),  to  perspiration; 
circular  douche,  95°  F.  CSS"  C),  twenty  seconds;  pressure,  26 
pounds;  fan  douche,  85°  to  75°  F.  (29.5°  to  23.9°  C),  twenty-five 

1  Amer.  Jour,  of  Insanity,  October,  1904. 

2  For  technic  see  p.  252. 


EFFECT   OF   COLD   BATHS   ON   METABOLISM  37 

seconds,  26  pounds;  jet,  65°  F.  (16.3°  C),  five  seconds,  20  pounds. 
The  treatment  was  varied  for  individual  cases.  These  studies, 
contrary  to  expectation,  failed  to  show  any  metabolic  changes, 
although  most  carefully  worked  out  on  the  basis  of  urinary  ex- 
cretion. The  thought  arises  that  there  may  have  been  other 
evidences  of  altered  metabolism  beside  those  shown  by  urinary 
analysis.  These  treatments  were  too  brief  to  produce  "  evi- 
dences of  altered  metabolism,"  and  there  was  not  sufficient 
alternation  of  temperature.  Beginning  with  95°  F.  (35°  C.) 
it  was  gradually  reduced  in  the  course  of  fifty  seconds  to  65°  F. 
(18.5°  C).  Baruch's  hyclrotherapeutic  law,  that  the  intensity 
of  effect  is  in  proportion  to  the  temperature  difference  between 
water  and  skin,  came  into  action  here.  The  skin  being  grad- 
ually cooled  down  does  not  present  the  temperature  contrast 
demanded  for  effects  upon  the  metabolism.  The  general 
records  showed  a  gain  because  the  treatment  was  gently  stim- 
ulating or  tonic,  increasing  appetite  and  enhancing  hema- 
tosis.  The  flexibility  of  water  is  demonstrated  in  the  different 
results  from  different  procedures.  Dr.  Baruch  has  pointed  out 
this  flexibility  with  emphasis  not  given  to  it  by  any  previous 
authority,  and  he  has  offered  a  rational  physiologic  basis  for 
every  procedure,  removing  all  apparent  paradoxes.  Patients 
free  to  eat  and  exercise  at  will  during  hydrotherapeutic  treat- 
ment will,  no  doubt,  gain.  The  general  records  of  the  McLean 
Hospital  show  that  of  216  consecutive  insane  cases  treated  with 
similar  baths,  and  on  the  usual  diet,  168  gained  in  weight  and 
48  lost.  The  gain  was  from  f  to  33f  pounds,  and  the  loss  from  ^ 
to  22|  pounds. 

The  experiments  of  Otto  Pospischil,  an  assistant  of  Winter- 
nitz,  show  that  the  rate  of  heat  production  is  increased  in  the 
cold  bath  by  vigorous  rubbing  by  as  much  as  44  per  cent.,  and 
this  may  to  a  great  extent  diminish  the  temperature. 

Short  cold  shower-baths  increase  heat  elimination  from 
25  to  66  per  cent.,  even  more  if  mechanical  friction  be  carried 
out.  He  also  found  the  flow  of  respiratory  air  to  be  increased 
nearly  three  times  in  the  half-bath.     Increased  vigor  is  undoubt- 


38  HYDROTHERAPY 

edly  the  result  of  the  procedure,  but  it  should  be  remembered 
that  if  the  water  be  at  the  higher  temperatures,  as  from  80°  to 
90°  F.  (26.7°  to  32.2°  C),  a  corresponding  increase  in  the  friction 
is  reciuired  to  produce  good  circulator}-  reaction.  By  raising  the 
temperature  of  the  water  and  communicating  heat  to  the  body, 
distinct  effects  on  metabolism  are  produced.  Carbon  dioxid  is 
exhaled  at  a  much  more  rapid  rate,  and  this  is  also  true  of  the 
application  of  cold  water.' 

Great  differences  in  the  reaction  to  cold  baths  are  noted  at 
different  times  in  the  same  individual.  Jurgensen  relates  the 
case  of  a  man  in  good  health  who  showed  no  fall  of  temperature 
in  or  after  a  bath  at  9°  C.  (48.2°  F.),  lasting  twenty-five  min- 
utes, but  four  days  later,  in  a  similar  bath  under  the  same  condi- 
tions, his  temperature  fell  to  33.9°  C.  (93°  F.). 

The  lower  the  temperature  of  the  bath  the  more  vigorously 
heat  production  and  heat  loss  proceed;  also,  during  the  first 
minute  in  the  bath  the  organism  gives  off  more  heat  than  in  the 
next,  and,  finally,  in  cold  baths,  after  a  certain  variable  period 
of  heat  loss,  the  rate  becomes  constant. 

In  a  bath  at  17.1°  C.  (62.8°  F.),  lasting  two  and  one-half 
minutes,  the  heat  production  was  fourteen  times  the  normal. 
The  subject  had  expended  64.63  calories  and  was  himself  .03°  C. 
(.08°  F.)  warmer.  It  is  an  interesting  point  that  of  these  65 
calories  43.76  were  given  off  in  the  first  minute  and  the  remainder 
in  the  following  one  and  one-half  minutes. 

In  another  experiment,  lasting  fifteen  minutes  in  a  bath  at 
26.75°  C.  (80.25°  F.),  the  heat  loss  in  the  first  five  minutes  was 
43 calories;  in  the  second  five  minutes,  15 calories;  in  the  third 
five  minutes,  17  calories. 

Ignatowski^  found  that  if  no  reaction  occurred,  the  heat  loss, 
by  radiation,  conduction  and  evaporation,  continued  to  decrease 
even  after  the  bath,  while  heat  production  was  lessened.    This 

^  Confirmed  by  experiments  of  Liebermeister,  Goldscheider,  Roehrjg, 
Zuntz,  and  Strasser. 

~  Ignatowski,  Der  Warmehaushalt  des  Menschen  nach  Badem  und 
Duschen,  Archiv  fiir  Hygiene,  51,  320,  1904. 


EFFECT   OF    COLD    BATHS   ON   METABOLISM 


39 


latter  was  directly  proportional  to  the  degree  of  cooling  reached, 
and  his  subjects  were  really  cooled  down  by  the  cold  baths.  If, 
on  the  contrary,  a  prompt  reaction  set  in,  the  diminished  loss  by 
radiation  and  conduction  could  scarcely  be  observed  and  that  due 
to  evaporation  rose  abnormally 

Rubner  made  some  studies  of  short  cold  douches  and  baths 
under  ordinary  conditions  of  life : 


Time,  three  to  five  minutes. 


Increase  of  respired  air 
Increase  of  CO,  output 
Increase  of  O  intake . . . 


Douche. 


Bath. 


16°C.(60.8°F.).  16°C.(60.8°F.). 


Per  cent. 

54.5 

149.4 

110.1 


Per  cent. 
22.9 
64.8 
46.8 


Baths  of  this  kind  affect  favorably  energy  and  fitness  for 
work.  Short  cold  baths,  in  wliich  actual  heat  loss  is  small, 
cause  a  fairly  marked  increase  in  chemic  metabolism  just  like 
the  longer  ones,  only  there  is  a  less  heat  deprival,  due  directly  to 
the  movements  which  the  baths  set  up.  The  heat  production 
due  to  muscular  activity  exceeds  and  obscures  the  catabolism 
due  to  cooling,  or  in  practice  renders  it  quite  negligible,  except 
under  very  unnatural  conditions.  It  is  impossible  to  determine 
the  extent  of  this  increased  catabolism  accurately,  because  no 
method  can  be  devised  which  will  deal  with  muscular  activity 
alone. 

Shivering  and  active  movements  in  connection  with  cold 
baths  are  thus  natural  aids  in  the  regulation  against  cold;  they 
produce  heat,  favoring  and  calling  forth  chemic  regulation,  and 
usually  fully  compensate,  or  may  overcompensate,  the  heat 
loss. 

If  the  heat  loss  in  a  healthy  and  moderately  fat  man  is 
estimated  during  a  period  of  fifteen  to  twenty-five  minutes,  it 
will  be  found  that  in  a  bath  at  40°  C.  (104°  F.)  the  heat  loss  is 
normal,  in  a  bath  at  30°  C.  (86°  F.)  it  is  almost  doubled,  and  in  a 
bath  at  25°  C.  (77°  F.)  is  tripled,  and   reaches  five  times  the 


40 


HYDROTHERAPY 


normal  at  20°  C.  (68°  F.)  (Liebermeistcr).     Riibner  made  the 
following  experimental  study: 


Effect  of  bathing  on  heat  production. 
Duration  of  bath,  one  hour. 


Heat  production  in  calories 

Heat  +  18  calories  for  heat  loss  in 

respiration 

Heat  —  91  calories,  which  a  man  of 

60  kg.  normally  produces 

Absolute  value  of    coolino;  of   the 

bath 

Metabolism  in  the  l)ath  reduced  to 

grams  of  fat 

Metabolism  in  bath.     Total  effect 

and  after-effect 


Temperature  of  bath. 


15°  C.        20°  C. 
(59°F.).    (68°F.). 


480 

498 

407 

81 

43 


370 

388 

297 

57 

31 

37 


25°  C.        30°  C.        35°  C. 
(77°  F.).   (86°  F.).!(95°  F.). 


240 

258 

167 

34 

18 

•^2 


150 
168 

77 
12 


80 
98 

7 


0.7 
0.7 


For  a  bath  lasting  fifteen  to  thirty  minutes  the  values  for 
heat  production  must  be  halved.  The  "cooling"  figure  remains 
the  same  if  the  time  is  not  shorter  than  fifteen  minutes.  "The 
effect  of  cold  water  on  the  body  surface  of  a  healthy  man  under 
normal  conditions  during  a  long-continued  application  does  not 
lessen  the  body  temperature  at  all ;  in  many  cases  it  even  raises 
it"  (Liebermeistcr),  so  that  within  limits  the  heat  loss  may  be 
at  first  overcompensated. 

Cold,  per  se,  reduces  the  oxidizing  capacity  of  animal  tissues. 
Warmed  tissues  have  a  much  higher  oxidizing  capacity.  In 
order  to  maintain  a  constant  normal  temperature,  we  are  com- 
pelled in  the  presence  of  cold  to  call  more  vigorously  than  usual 
on  our  heat-regulation  powers  so  as  to  increase  our  oxidative 
activity.     Hence  in  eclampsia  we  should  resort  to  the  use  of  heat. 

Rubner*  has  found  that  in  an  experimental  guinea-pig  the 
metabolism  at  0°  C.  is  two  and  one-half  times  that  at  30°  C. 
Rubner  also  showed  that  a  bath  at  16°  C.  increased  the  oxygen 
absorption  46.8  per  cent.,  and  a  douche  at  16°  C.  increased  the 
oxygen  absorption  110  per  cent. 

1  Energiegesetze,  1902,  Ditman  and  Walker,  N.  Y.  IMed.  Jour.,  I\Iay  15- 
June  5.  1909;  see  also  Matthes,  Lelu-buch  der  klinischen  Hydrotherapie,  Part 
i,  Chapter  iii. 


QUANTITATIVE   ESTIMATION   OF   AMOUNT   OF   HEAT   LOSS      41 

QUANTITATIVE  ESTIMATION  OF  THE  AMOUNT  OF  THE  HEAT 
LOSS.    HEAT  REGULATION. 

This  has  been  estimated  under  various  conditions  in  number- 
less experiments  by  Prof.  Winternitz  according  to  methods  fully- 
explained  in  his  various  works,  particularly  in  his  last  publica- 
tion, Physiologische  Grundlagen  der  Hydro-  und  Thermo- 
therapie.^     Briefly  stated,  it  is  as  follows: 

1.  Displacement  of  the  blood  and  arresting  of  the  circula- 
tion in  a  limb  with  an  Esmarch  bandage  lowers  the  heat  produc- 
tion 70.6  per  cent. 

2.  Restriction  of  the  circulation  by  passive  hyperemia,  Bier 
method,  lowers  the  heat  production  46.2  per  cent. 

3.  Mechanical  stimuli  increase  the  heat  production  95  per 
cent. 

4.  Weak  chemical  stimuH  are  able  to  raise  the  heat  produc- 
tion as  much  as  40  per  cent.,  while  strong  chemical  stimuli  may 
lower  it  8  per  cent. 

5.  Thermic  influences,  such  as  cause  cutis  anserina  (goose- 
flesh),  lower  the  heat  production  as  much  as  44.5  per  cent. 

6.  A  warm  rain-bath,  by  production  of  gooseflesh,  can  cause 
lowering  of  heat  production  by  38.7  per  cent. 

7.  Partial  cold  wet  rubbing,  or  a  partial  application  of  the 
drip  sheet,  can  increase  the  heat  production  by  80  per  cent. 

8.  A  cold  rain-bath  followed  by  rest  on  a  couch  produces, 
after  a  slight  lowering  of  the  heat  production,  an  increase  to 
23  per  cent. 

9.  A  cold  rain-bath  followed  by  exercise  can  raise  the  heat 
production  66.6  per  cent. 

10.  A  warm  rain-bath  with  a  cold  fan  douche,  followed  by 
rest  on  a  couch,  can  raise  the  heat  production  by  16  per  cent. 

11.  In  febrile  diseases  in  the  presence  of  rising  body  tempera- 
ture the  heat  production  may  be  lowered  25.4  per  cent. 

This  is  better  shown  in  Fig.  3. 

Cold  applications  have  a  good  moral  effect  in  cultivating 
will  power.    While  the  effect  of  such  stimulations  may  be  for  a 

1  Stuttgart,  Verlag  von  Ferd.  Enke,  1906. 


42 


HYDROTHERAPY 


time  unpleasant,  particularly  at  the  outset,  the  patient  soon 
feels  their  benefit  and  is  encouraged  to  continue  them.  Encour- 
agement, suggestion,  firmness,  and  kindness  from  the  attendant 
and  the  personal  interest  and  presence  of  the  physician  will  do 
much  at  this  stage  to  secure  the  cooperation  and  confidence  of 
the  patient  and  his  continuance  in  the  prescribed  method  of 
treatment.  Physicians  do  not  always  realize  the  mental  anguish 
which  some  poor  creatures  undergo  when  they  begin  a  new  and 
what  appears  to  them  a  formidable  course  of  hydrotherapy. 


^ 


/CO 
9o 


70. 


JO  . 


/o 

-Zo 

3o 

So 

60 


7o. 


A/orma/ /  2  j       Ma-    <>  h      S         6        A  4  ? 


± 


Fig.  3. — 1,  Esmarch  bandage;  2,  passive  hyperemia;  3,  mechanical  stimuli; 
A,  a,  weak,  and  b,  strong,  chemical  stimuli;  5,  cutis  anserina;  6,  warm  rain-bath 
and  cutis  anserina;  7,  partial  rubbing  (cold  water);  8,  cold  bath  and  rest;  9,  cold 
bath  and  exercise;   10;  warm  rain-bath;  cold  fan  douche  and  rest;   11,  active  fever. 


Some  patients  are  hopeful  and  confident,  others  are  apprehensive 
and  distrustful. 

Dr.  Baldwin,  of  Boston,  relates  that  one  of  his  patients,  who 
had  long  felt  unable  to  do  anything  by  reason  of  fancied  weak- 
ness, went  to  the  baths  taking  with  her  a  sheet  so  that  she  might 
be  properly  wrapped  up  when  they  brought  her  dead  body  home. 
But  kindly  management  gave  her  confidence  and  the  baths  which 
she  took  so  improved  her  condition  that  health  and  activity  were 
restored.     As  Baldwin  says,  "Cases  of  mental  depression  derive 


QUANTITATIVE   ESTIMATION   OF   AMOUNT   OF   HEAT   LOSS      43 

much  benefit  from  the  baths;  neurasthenic  and  psychasthenic 
patients  are  very  likely  to  derive  benefit  from  hydrotherapy, 
but  they  usually  expect  miracles,  and  that,  too,  without  efi'ort 
or  anything  disagreeable  on  their  part.  So  it  is  that  the  doctor 
must  insist  on  having  his  directions  carried  out.  It  is  simply  a 
question  of  whether  the  doctor  will  run  the  case  and  cure  the 
patient,  or  whether  the  patient  will  continue  to  do  as  he  pleases 
and  run  the  doctor  until  such  time  as  he  dismisses  him  as  an  in- 
competent person.  Dr.  Baldwin^  wisely  remarks  that  these 
patients  must  be  made  to  do  something  else  than  to  sit  around 
bemoaning  their  condition,  and  bathing  is  useful  in  occupying 
their  time;  they  derive  at  the  same  time  the  benefit  of  the  baths 
in  the  way  of  improved  circulation  and  improved  processes  of 
metabolism.  The  baths  take  the  patient  completely  out  of  him- 
self for  the  time  being,  and  though  the  patient  does  not  usually 
like  the  bath,  he  feels  that  something  active  is  being  done  for  him. 
In  different  cases  a  good  deal  of  personal  persuasion  is  required 
until  a  reasonable  attitude  is  assumed  by  the  patient  toward  the 
prescribed  treatment.  Of  course,  in  institutions  a  better  control 
of  the  patient  obtains  than  in  attempting  treatment  in  private 
practice.  At  the  McLean  Hospital  at  Waverly,  Massachusetts, 
Dr.  Tuttle  had  a  patient  who  was  possessed  with  the  delusion  of 
demoniacal  possession,  and  after  reahzing  that  he  was  being 
improved  wrote  this:  "Your  baths  are  excellent  to  reduce  cere- 
bral excitement.  You  can't  fight  the  devil  with  fire,  he  is  in  his 
element  there,  but  he  is  mortally  afraid  of  cold  water." 

Undoubtedly,  cases  will  present  themselves  in  which  it  is  im- 
possible even  for  those  of  experience  to  foretell  what  the  effect  of 
hydrotherapeutic  measures  will  be.  Especially  is  this  true  in  dis- 
orders of  psychic  origin  or  when  patients  are  sent  by  physicians 
who  have  been  familiar  with  their  history  to  other  physicians 
who  may  not  know  the  idiosyncrasies  and  peculiarities  of  the 
patient  thus  despatched  to  a  sanitarium  or  health  resort. 
Patients  must  be  studied  individually  in  the  light  of  a  full  letter 
of  advice,  and  time  must  be  taken,  with  moderate  procedures,  to 

^  Boston  Medical  and  Surgical  Journal,  April  15,  1909. 


44  HYDROTHERAPY 

arrive  at  a  proj^cr  estimate  of  the  best  course  to  follow.  Dr. 
George  Beard,  in  condemning  routine  methods,  wisely  said: 
"  If  two  cases  are  given  the  same  treatment  from  beginning  to  end 
it  is  probable  that  one  of  them  has  been  improperly  treated." 
Dr.  Pratt,  in  cases  of  doubt,  has  sometimes  followed  Binswang- 
er's  method  in  giving  three  different  treatments  on  three  suc- 
cessive days.  After  these  have  been  repeated  once  or  twice  the 
treatment  which  seems  to  the  patient  to  be  most  beneficial  is 
selected.  Usually  one  of  the  procedures  will  be  condemned  and 
one  favored.  In  this  way  the  support  and  confidence  of  the 
patient  is  gained. 

The  following  sample  outline  of  treatment  is  given  as  a  sug- 
gestion : 

First  day:  Electric-light  bath,  five  to  ten  minutes,  followed 
by  wet  mit  friction. 

Second  day :  Carbon  dioxid  bath  (one-half  full  strength),  ten 
minutes. 

Third  day :  "Wet  pack,  duration  forty-five  minutes  to  one  hour. 

Repeat  treatments  in  the  same  order  on  the  fourth,  fifth,  and 
sixth  days. 

Dr.  Pratt  advises  that  half  an  hour  to  an  hour  of  physical 
and  mental  rest  should  follow  each  treatment,  unless  the  patient 
is  robust  and  with  good  reactive  powers,  when  a  brisk  walk  may 
be  substituted.  Often  it  is  a  good  idea  to  combine  rest  and  ex- 
ercise by  having  the  j^atient  dress  quickly,  walk  a  certain  dis- 
tance, and  on  reaching  home  rest  in  bed  for  thirty  minutes  to  an 
hour.  A  good  proportion  of  the  neurasthenic  patients  wish  to 
discontinue  treatment  after  the  first  or  second  bath  has  been 
taken.  In  many  neurasthenic  women  a  feeling  of  exhaustion 
comes  on  a  short  time  after  the  treatment  and  persists  the 
remainder  of  the  day.  This  is  usually  regarded  both  by  phys- 
ician and  patient  as  evidence  that  the  hydrotherapeutic  pro- 
cedure has  been  too  strong,  but,  as  this  temporary  exhaustion 
develops  after  the  mildest  treatments  and  as  it  almost  invariably 
disappears  after  the  second  or  third  treatment,  the  sensation  of 
weakness  is  undoubtedly  due  in  the  great  majority  of  cases  to  the 


THE    EFFECT    OF    HOT    BATHS    ON   METABOLISM  45 

nervous  strain  of  the  visit  to  the  institution.  The  surroundings 
are  new  and  the  appHances  are  strange  and  somewhat  formidable 
in  appearance.  Dr.  Pratt  relates  that  he  recently  saw  a  patient 
in  whom  weakness  and  depression  persisted  until  the  sixth  treat- 
ment. Since  then  she  has  felt  refreshed  and  invigorated  after 
the  bath  for  the  rest  of  the  day.  It  was  possible  to  prove  beyond 
question  in  this  instance  that  the  weakness  was  of  purely  psychic 
origin  because  the  patient  felt  as  tired  after  a  mild  treatment 
(wet  mit  friction)  as  after  a  strong  one  (circular  and  horizontal 
douche) . 

Effect  of  Cold  Baths  (Brand  Baths)  on  the  Urine.— 
James  Tyson  measured  the  total  daily  amount  of  urine  and 
the  actual  amount  and  percentage  of  urea  excreted  during  an 
entire  month  by  a  patient  who  had  typhoid  fever  and  was 
treated  by  Brand  baths,  numbering  53  during  the  first  two  weeks. 
There  was  an  increase  in  the  urinary  secretion,  and  on  one  day, 
early  in  the  case  after  5  baths  had  been  given,  66  ounces  (1980 
cc.)  were  voided.  An  albuminuria  with  casts  {cloudy  swelling) 
disappeared  during  the  treatment. 

During  hydrotherapy  according  to  Brand's  method  the  toxic 
'property  of  the  urine  secreted  is  undoubtedly  increased  as  con- 
trasted with  the  urine  in  cases  not  tubbed.  Ausset  attributes 
the  entire  efficiency  of  the  Brand  baths  to  this  active  elimina- 
tion of  toxic  agencies.^ 

It  is  said  that  excessively  cold  procedures  may  produce 
hemoglobinuria  and  albuminuria.  (For  further  discussion  of 
this  subject  see  pp.  238,  240.) 

Albumin  may  be  met  with  in  predisposed  persons  after  a 
cold  bath,  especially  in  the  cyclic  albuminuria  of  adolescence. 

THE  EFFECT  OF  HOT  BATHS  ON  METABOLISM 
In  the  case  of  hot  baths  there   is    no   mechanism  corre- 
sponding to   the  increased   oxidation   by  which  lack  of  heat 
is  compensated  for  whereby  the  organism  can  reduce  its  heat 

1  James  Tyson,  Trans.  Association  Amer.  Physicians,  1897;  E.  Ausset, 
Bull,  et  Memoires  de  la  Societe  Med.  des  Hopitaux  de  Paris,  Tome  11,  3  serie, 
1894,  p.  825. 


46  HYDROTHERAPY 

production  or  decrease  its  metabolism.  When  exposed  to 
heat  or  when  heat  loss  is  prevented,  the  body  temperature  is 
governed  only  by  physical  regulation;  that  is,  it  is  a  (lues- 
tion  of  evaporation;  if  this  is  checked,  the  body  temperature 
necessarily  rises.  Winternitz  showed  that  the  increase  in  the 
consumption  of  oxygen  caused  by  a  moderately  hot  bath  far 
exceeds  that  due  to  fever,  and  that  there  was  a  marked  in- 
crease in  metabolism,  the  carbon  dioxid  out{)ut  and  the  oxygen 
intake  going  hand  in  hand;  the  heat  balance  being  impaired, 
oxidation  increases.  It  has  also  been  shown  that  the  body  tem- 
perature can  still  go  on  rising  for  a  short  time  after  the  end  of 
a  hot  or  vapor  bath  because  the  thoroughly  heated  skin  must  for 
a  time  continue  to  act  as  though  it  were  still  in  the  hot  bath.^ 
This,  however,  is  adjusted  in  the  course  of  an  hour  or  two,  and 
afterward  a  slightly  subnormal  temperature  and  a  slight  second- 
ary rise  has  been  noted. 

This  fall  after  hot  baths  might  be  expected  to  be  greater  than 
it  is,  considering  the  fact  that  the  skin  is  left  in  such  a  highly 
vascular  state.  Winternitz,  for  example,  found  that  the  oxygen 
consumption  in  1  case  was  increased  by  28  per  cent,  even  seventy- 
five  minutes  after  the  bath. 

Comparing  the  effect  of  a  hot  bath  at  44°  C.  (111.2°  F.)  and 
a  cold  bath  at  16°  C.  (60.8°  F.),  Rubner  found  the  increase  of 
inspired  air  18  per  cent,  in  the  former  against  22.9  per  cent,  in 
the  latter;  the  increase  of  carbon  dioxid  output  was  32.1  per 
cent,  in  the  hot  bath  and  64.8  per  cent,  in  the  cold;  the  increase 
of  oxygen  intake  was  17.3  per  cent,  against  46.8  per  cent.  Re- 
peated hot  baths  accentuate  this  metabolic  change  as  compared 
with  the  results  obtained  from  a  single  bath. 

Hot  baths,  without  the  usual  water-drinking,  diminish  the 
urine,  since  they  promote  sweating.  Cold  baths  increase  the 
amount  of  the  urine  temporarily.  This,  however,  is  usually 
quickly  compensated  for.  The  increased  secretion  depends  on 
the  raised  blood-pressure  due  to  cold. 

*  Speck,  Ueber  den  Einfluss  warmer  Bader  auf  den  Atmungsprocess, 
Deutsches  Archiv  fiir  Klin.  Med.,  37,  1885. 


THE    EFFECT   OF   HOT   BATHS   ON   METABOLISM  47 

Experiments  show  that  as  much  as  1  quart  of  sweat  may  be 
lost  in  a  prolonged  hot-air  bath.  Dr.  J.  H.  Pratt  has  noted  a 
loss  of  1500  gm.  during  an  energetic  hot-air  bath,  and  it  can 
be  readily  understood  that  this  abstraction  of  fluid  must  affect 
the  entire  circulation  of  blood  and  lymph  and  undoubtedly  aid 
in  the  eUmination  of  morbid  products.  The  abnormally  high 
concentration  of  blood  present  in  renal  insufficiency  can  be 
reduced  by  sweating,  and  in  these  cases  the  low  nitrogen  con- 
tent and  the  molecular  concentration  of  sweat  is  thereby  con- 
siderably increased.  Reference  will  be  made  later  on  to  the 
increased  secretion  of  sweat  in  the  elimination  of  various  poisons, 
including  lead,  mercury,  and  bacterial  toxins.^ 

Uric  Acid. — Both  Formanek"  and  B.  Laquer^  found  that  the 
excretion  of  uric  acid  was  increased  after  hot  baths.  Formanek 
found  also  that  a  single  cold  bath  is  without  effect,  but  that  two 
long  cold  baths  daily  increase  the  uric  acid  output.  Ebstein,* 
however,  claims  that  the  uric  acid  excretion  is  not  changed  by  the 
use  of  baths.  In  estimating  uric  acid  excretion  it  may  be  con- 
sidered as  10  per  cent,  of  the  total  nitrogen  eliminated,  urea 
amounting  to  85  per  cent 

Sugar. — As  for  sugar,  it  has  been  found  that  when  glycosuria 
has  been  produced  artificially  by  administering  large  amounts 
of  grape-sugar  simultaneously  with  diuretics,  free  sweating  sup- 
presses the  glycosuria  and  the  sugar  appears  in  the  sweat.  This 
is  an  experimental  demonstration  of  the  vicarious  action  of  the 
skin  which  is  occasionally  noted  in  disease. 

1  J.  H.  Pratt,  The  Development  of  Scientific  Hydrotherapy,  Boston  Med. 
and  Surg.  Jour.,  Jan.  25,  1906. 

2  Ueber  den  Einfluss  Kalter  Bader  auf  die  Stickstoff  und  Hamsaureaus- 
scheidung  beim  Menschen,  Zeitschr.  fur  Physiol.  Chem.,  Bd.  19,  271,  1894. 

3  Ueber  die  Ausscheidungs  erhaltnisse  der  AUoxurkorper  im  Hame  von 
Gesunden  und  Kranken,  Verhandl.  des  14th  Kongr.  fiir  innere  Medizin,  333, 
1896. 

*  Flechsig  also  states  that  the  excretion  of  urea  is  diminished  by  carbonated 
baths. 


48  HYDROTHKRAPY 

TEPID,   OR   INDIFFERENT  BATHS 

have  no  effect  on  the  metabolism.  Salt  baths  at  indifferent 
temperatures  likewise  have  no  effect,  but  when  hot  or  cold  they 
are  more  lasting  in  their  metabolic  effect  than  in  the  case  of  plain 
water  at  the  same  temperatures. 

EFFECT  OF  BATHS  ON  BLOOD-PRESSURE 

Ever}'  hot  or  cold  douche  calls  forth  an  increase  of  blood- 
pressure,  paradoxic  as  it  may  seem.  Cold  l)aths  contract  the 
capillaries  of  the  skin;  there  is  a  slower  but  more  vigorous  con- 
traction of  the  heart  and  consequent  rise  of  pressure.  Baths 
between  95°  and  104°  F.  (35°  and  40°  C.)  produce  a  primary 
rise,  a  secondary  fall  below  normal,  then  a  rise.  Baths  above 
104°  F.  (40°  C.)  increase  the  pressure  and  also  the  pulse  rate,  the 
pressure  remaining  high.  In  baths  accompanied  by  meclianical 
excitation  the  pressure  is  augmented,  but  returns  easily  to  nor- 
mal.' 

Carbonic  acid  or  Nauheim  baths  between  the  temperatures 
of  84°  F.  (29°  C.)  and  89.6°  F.  (32°  C.)  do  not  lower  a  path- 
ologic hypertension.  Above  the  latter  figures  there  is  a  marked 
fall,  which,  however,  tends  to  rise  even  above  the  original  ten- 
sion after  the  bath;  but  this  increase  is  not  permanent.' 

It  follows  that  in  the  application  of  an  agent  which  affects 
the  blood-pressure  so  noticeably  care  should  be  taken  not  to 
aggravate  any  state  of  the  system  that  cannot  bear  such  an 
influence.  We  should  carefully  note  any  weakness  of  the  heart 
or  blood-vessels,  so  as  to  avoid  any  accident,  for  undoubtedly 
accidents  have  occurred  through  neglect  of  this  precaution. 
Dr.  Osier  has  said  that  longevity  is  a  cardiovascular  f{uestion. 
To  a  majorit)''  of  men  death  comes  primarily  or  secondarily 
through  this  portal.     For  that  reason  the  greatest  care  should 

'  A  full  discussion  of  this  subject  is  found  iu  Dr.  Barucli's  Hydrotherapy, 
third  ed.,  New  York;  also  Therapeutics  of  the  Circulation,  by  Sir  Lauder 
Brunton,  Phila.,  1908. 

-  See  Hvirter,  Zeitschrift  fiir  phys.  und  dietct.  Therapie,  Bd  12,  1908;  see 
also  Jour.  Amer.  Med.  Assoc,  April  23,  1910,  pp.  1376,  1377. 


THE   SPHYGMOMANOMETER 


49 


be  exercised  at  all  times,  but  especially  after  middle  life,  to  see 
that  the  circulatory  organs  are  preserved  and  not  weakened  by 
sudden  and  unusual  strain. 

THE  SPHYGMOMANOMETER 

One  of  the  aids  in  the  recognition  of  hypertension  is  the 
spygmomanometer  as  devised  by  Mosso,  von  Basch,  Potain  and 
Riva  Rocci,  and  modified  by  Sir  Lauder  Brunton,  C.  J.  Martin, 
Cook,  Stanton,  and  Theodore  Janeway.   It  is  perfectly  practical. 


Fig.  4. — Dr.  C.  J.  Martin's  modification  of  the  Riva-Rocci  sphygmomanometer. 

quickly  used,  and  has  been  found  of  great  value,  supplementing 
the  stethoscope  in  estimating  the  state  of  the  vascular  system. 

In  making  a  sphygmographic  tracing  of  the  pulse  we  can  read- 
ily see  the  effect  on  the  blood-vessels  by  the  cold  spray  or  bath. 
The  pulse  rate  is  slowed,  the  upward  stroke  is  lessened,  and  the 
dicrotic  wave  is  less  pronounced.  The  tracings  made  by  Marey, 
Sir  Lauder  Brunton,  Bezley  and  Leslie  Thome,  and  W.  H.  Riley 
show  this  plainly.  The  upstroke  is  nearly  vertical.  It  occurs  dur- 
ing the  dilatation  of  the  artery  and  is  produced  by  the  systole  of 
the  left  ventricle.    The  line  of  descent  is  gradual  and  corresponds 

4 


50 


HYDROTHERAPY 


to  the  diminution  in  diameter  of  the  arteries,  and  as  it  falls  the 
dicrotism  appears.    The  height  of  the  up  stroke  indicates  the  force 


Fig.  5. — Faught's  blood-pressure  apparatus. 

of  the  systole,  but  at  the  same  time  its  height  is  restricted  if  the 
arteries  are  tense  and  rigid.     A  relaxed  and  dilated  condition 


Fig.  6. — Stanton's  sphygmomanometer. 


of  the  blood-vessels  favors  an  increase  in  the  length  of  the  up 
stroke;  and  conversely,  arterial  hypertension  shows  itself  in  a 


THE    SPHYGMOMANOMETER 


51 


lower  stroke  and  a  less  marked,  tiicrotie- wave.-  -A  pew^M  heart 
may  be  matched  against  a  weakened  artery.     Of  course,  no  harm 


'     Fig.  7. — Dr.  Rogers'  "Tycos"  sphygmomanometer:  a,  Gauge,  actual  size. 

results  when  the  vessels  are  resilient  and  free  from  atheroma; 
the  accelerated  circulation  under  favorable  circumstances 
restores  the  nervous  system  and  promotes  health. 


Fig.  8. — ^Tracing  of  a  normal  pulse  (Sir  Lauder  Brunton). 


HYDROTHERAPY 


Fig.  9. — ^Tracings  of  healthy  pulse  with  varying  degrees  of  tension:  1,  Ten- 
sion is  high,  owing  to  the  contraction  of  the  arterioles  from  cold;  2  and  3,  di- 
minished tension  from  warm  clothing,  showing  relaxation  of  the  arterioles  (Sir 
Lauder  Brunton,  after  Marey). 


GF  28-10-98.   before  I-  bath    3ior. 


Fig.  10. — ^Tracing  from  the  pulse  of  a  patient  aged  sixty-two  with  gouty  kidney, 
of  a  failing  heart.  This  tracing  and  the  three  following  show  the  effect  of  Nauheim 
baths  in  increasing  the  cardiac  force  and  dilating  the  vessels  (Sir  Lauder  Brunton). 


1  F  2^-^0-98   3*^9-    I'--   b3^h     3i 


Fig.  11. — Effect  of  one  bath  (Sir  Lauder  Brunton). 


I\       ^ 


after  14^^  bath  3:2"-^  effervescing  bath  3toi. 


Fig.  12. — From  the  same  patient  (Sir  Lauder  Brunton). 


COUNTERINDICATIONS   TO    BATHS 


53 


Fig.  13. — From  the  same  patient  after  nineteen  baths  (Sir  Lauder  Brunton). 


COUNTERINDICATIONS  TO  BATHS 
A  positive  counterindication  to  such  measures  as  the  Nauheim 
bath,  for  instance,  is  any  acute  or  subacute  condition  of  the  heart, 
and,  on  the  other  hand,  the  loss  of  compensation,  as  in  chronic 
heart  disease.  In  aneurysm  great  care  should  be  exercised/  It  is 
highly  necessary  to  satisfy  one's  self  that  these  conditions  do  not 
exist  before  prescribing  the  more  stimulating  measures.  Palpa- 
tion and  percussion  of  the  heart  and  the  use  of  the  sphygmo- 
manometer are  good  routine  methods  before  prescribing  hydro- 
therapy; just  as  on  a  dangerous  coast  a  navigator  takes  frequent 
soundings,  the  more  often  as  the  channel  is  obscured,  avoiding 
the  shoals  and  inevitable  shipwreck.  We  know  that  the  blood- 
vessels can  bear  a  strain  of  250  to  300  mm.  of  mercury  as  shown 
by  the  sphygmomanometer.  H.  W.  Cook^  has  called  attention 
to  this  subject: 

''Overexertion,  either  physical  or  mental,  anxiety,  over- 
eating— especially  of  meats  and  certain  toxins  (auto,  bacterial, 
metallic,  or  alkaloidal) — produce  a  rise  in  blood-pressure,  and, 
therefore,  added  strain  on  the  cardiovascular  system,  upon  the 
integrity  of  which  life  and  health  so  directly  depend.  This  rise 
in  blood-pressure,  in  part  physiologic,  becomes,  when  protracted 
over  extended  periods,  a  most  pernicious  and  potent  factor  in 
inducing  the  train  of  cardiovascular  diseases  which  develop  in 
clinical  manifestation,  as  cerebral  apoplexy,  aneurysm,  arterio- 
sclerosis, vertigo,  angina  pectoris,  and  nephritis.  After  the 
terminal  affections  have  fully  developed  into  clinical  entities,  it 
is  too  late  to  establish  corrective  treatment." 

^  The  author  has  given  these  baths  in  a  case  of  aneurysm  of  the  arch  of  the 
aorta  with  benefit.  2  Trans.  Medical  Society  of  Virginia,  1904. 


54 


HYDROTHERAPY 


EFFECTS  OF  THE  HOT-AIR  BATH 

The  effect  of  the  hot-air  bath,  circular  aud  cool  fan  douche, 
have  been  recorded  by  Dr.  George  T.  Tuttle*  in  the  case  of  10 
women,  nurses  and  patients  in  the  McLean  Asylum.  The  in- 
strument used,  was  that  of  liiva-llocci.  The  averages  noted 
represent  at  least  ten  observations.  He  shows  that  there  is  a 
sudden  fall  of  blood-pressure  from  5  to  34  nmi.  of  mercury,  but 
this  rises  quickly  to  normal  or  above  when  the  cool  douche  is 
applied. 

EFFECT  OF  BATHS  ON  THE  RATE  OF  THE  HEART 

The  most  striking  results  are  noted  under  the  influence  of  the 
hot-air  bath  followed  by  cool  douches.     In  the  hot-air  cabinet 


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Fig.  14. — Effect  of  thermic  stiiimlus  on  the  pul.se-rate.  Showing  a  primary  rise 
and  a  secondary  fall  of  the  pulse.  Hot-air  cabinet,  165°  F.  (73.8°  C),  eight  min- 
utes; jet  douche,  two  minutes.  105°  F.  (40..5°  C),  reduced  to  90°  F.  (32.2°  C); 
Scotch  douche,  105°  and  80°  F.  (40.5°  and  26.6°  C),  one  minute;  and  douche,  thirty 
seconds,  at  78°  F.  (25.5°  C.) ;  rest  on  couch.  Figures  14,  15,  and  16  are  from  cases 
observed  by  the  author  at  Hot  Springs,  Virginia. 

1  American  Journal  of  Insanity,  October,  1904. 


EFFECT  OF  BATHS  ON  THE  RATE  OF  THE  HEART 


55 


Fig.  15. — Showing  the  effect  of  thermic  stimulus  on  the  pulse. 

Patient  A.- — -Hot-air  cabinet  bath  at  165°  F.  (73.8°  C),  six  minutes;  circular 
douche,  seventy  seconds,  80°  to  70°  F.  (26.6°-21.1°  C),  two  minutes.  Drying  and 
rest  on  the  couch.      Primary  rise  of  the  pulse  to  130;  secondary  fall  to  70. 

Patient  B  showed  a  lower  primary  rise  and  in  two  minutes  a  fall  from  118 
to  76. 


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Fig.  16. — Chart  showing  the  effect  of  thermic  stimulation  on  the  pulse.  Ob- 
servations made  on  Mr.  P.,  aged  forty-seven,  on  different  daj's.  Heart  and  circu- 
lation normal.  The  upper  line  represents  a  hot-air  cabinet  bath,  temperature 
173°  F.  for  eleven  minutes;  circular  douche  103°  > 85°,  20  pounds;  two  minutes; 
jet  douche,  100°  >  70°  F.,  for  one  minute,  20  pounds;  Scotch  douche,  120°  and  70°, 
twenty  seconds,  20  pounds;  Fan  douche,  75°,  ten  seconds,  25  pounds.  Initial  pulse 
72;  maximum  pulse,  112;  minimum  pulse  (20  in  minute),  66. 

In  the  second  bath  the  temperature  of  the  hot-air  cabinet  was  1 65°  F.  Dura- 
tion ten  minutes.  Circular  douche,  106°  >  85°,  two  minutes,  21  pounds;  jet  douche, 
105°  >  70°,  one  minute,  22  pounds;  Scotch  douche,  105°  and  70°,  fifteen  seconds, 
21  pounds;  fan  douche,  68°,  ten  seconds. 


56  HYDROTHERAPY 

at  a  temperature  of  170°  F.  (76.66°  C.)  the  author  has  noted  a 
rise  in  rate  from  about  70  to  120  per  minute,  antl  as  the  douche 
was  cooled  to  65°  F.  (18.33°  C.)  the  pulse  rapidly  fell.  A  drop 
of  60  beats  inside  of  five  minutes  or  less  has  been  noticed,  and, 
as  the  patient  was  rubbed,  the  rate  rose  to  a  little  above  normal. 
Such  changes  in  the  rate  and  slight  changes  in  the  rhythm 
should  be  expected.  They  illustrate  the  (juick  res})onse  which 
the  circulatory  system  makes  to  the  stimulus  of  water  applied  in 
this  manner.     (See  Figs.  14,  15,  16.) 

THE  EFFECT  OF  BATHS  ON  THE  BLOOD 

The  effect  of  baths  on  the  blood-count  has  been  carefully 
studied  by  Dr.  Fernald,  who  found  that  there  is  sometimes  an 
increase  and  again  a  diminution  in  both  the  red  and  white 
cells,  and  sometimes  an  increase  in  one  and  a  decrease  in  the  other. 
If  the  cold  bath  be  prolonged,  the  surface  vessels  allow  an  irreg- 
ular distribution  of  cells  and  plasma,  owing  to  the  contraction 
of  the  surface  capillaries  by  cold.  Under  strong  contraction  it 
is  believed  that  the  plasma  may  run  on  and  leave  the  cells 
stranded.  In  all  general  measures  producing  a  decided  hy})er- 
emia  of  the  skin,  it  must  follow  that  a  corresponding  amount  of 
blood  is  withdrawn  from  the  internal  organs;  and,  again,  as  the 
skin  is  rendered  temporarily  anemic,  the  blood  returns  to  the 
deeper  recesses  of  the  body.  In  this  manner  both  derive  benefit, 
and  the  abdominal  viscera  particularly  become  less  lethargic  and 
by  increased  activity  favor  well-being. 

Hydrotherapy  thus  starts  a  conflict  between  the  center  and 
the  periphery  for  the  possession  of  the  blood,  and  its  influence  in 
promoting  a  rapid  interchange  is  doubtless  more  significant  than 
any  particular  change  in  the  ratio  of  its  various  elements. 

In  all  general  procedures  in  which  thermic  and  mechanical 
stimuli  of  not  too  intense  a  type  are  applied  to  the  entire  sur- 
face of  the  body,  with  very  few  exceptions,  there  is  r^ot  merely 
a  diminution  of  the  leukoc3^tes,  but  an  increase  of  the  red 
blood-cells  when  a  test  is  made  from  the  finger-tip  or  the  ear. 


EFFECT   OF   COLD   AND   HEAT    UPON  RESPIRATION  57 

The  hemoglobin  may  also  be  increased  by  about  14  per  cent, 
according  to  Wintemitz.  Moderate  procedures  are  thus  favor- 
able for  anemic  patients  (see  p.  159).  Warm  packs  and  com- 
presses tend  to  increase  the  leukocytes  and  diminish  the  red 
cells. 

Paroxysmal  hemoglobinuria  has  been  known  to  occur  after 
very  cold  baths.  This  has  been  ascribed  to  some  hemolytic  prop- 
erty imparted  to  the  plasma. 

EFFECT  OF  COLD  AND  HEAT  UPON  RESPIRATION 

The  cold  douche  produces  at  first  short,  gasping  respiratory 
movements,  a  sudden  cold  stream  under  high  pressure  producing 
the  most  marked  effect.  A  full  cold  bath  produces,  after  the 
first  few  moments,  slow,  full,  and  deep  respiratory  movement. 
The  cold  douche  or  spray  accelerates  the  respiratory  rate. 

Dry  heat  retards  the  respiratory  gaseous  interchange,  in- 
creases the  rate  of  respiration,  but  at  the  same  time  renders  it 
less  efficient  and  deep. 

During  a  hot  bath,  although  the  rate  is  increased,  the  respira- 
tions gradually  become  deeper.  'The  skin's  action  is  increased, 
but  there  is  a  corresponding  elimination  through  the  lungs  of 
much  moisture  and  toxic  material. 

The  sudden  stimulus  of  hot  water,  as  in  the  case  of  sudden 
stimulus  by  cold,  tends  to  check  the  breathing  in  the  act  of 
inspiration.  In  very  hot  baths  or  those  that  are  long  con- 
tinued, especially  w^hen  the  patient  is  not  accustomed  to  them, 
there  is  liable  to  be  dyspnea  and  weakness  of  the  heart.  In 
electric-light  baths  there  is  an  increase  in  the  respiration  rate 
corresponding  to  the  elevation  of  temperature.  We  see,  then, 
that  the  rate  is  increased  by  both  heat  and  cold. 


SPECIAL  HYDROTHERAPY 

Ix  ancient  times  water  was  highly  regarded  as  a  restorative, 
and  there  arc  many  classic  allusions  to  the  value  of  warm  baths. 
These  were  especially  advised  for  the  aged  and  commonly  adopted 
among  the  Greeks.  Ulysses,  on  his  return  from  Ithaca,  found 
his  father,  Laertes,  greatly  debilitated,  and  immediately  adviserl 
warm  bathing. 

Ulysses,  in  his  famous  visit  to  Circe,  was  treated  to  a  most 
luxurious  bath,  which  Homer  describes  in  the  Odyssey:  "And 
four  handmaidens,  who  are  her  servants  in  the  house,  were  busy 
in  the  place.  But  they,  indeed,  were  sprung  from  the  fountains 
and  from  the  groves,  and  from  the  sacred  rivers  which  flow  forth 
into  the  sea.  One  of  them  threw  beautiful  blankets  upon  the 
thrones,  purple  above;  but  under  she  put  beautiful  linen;  another 
extended  silver  tables  before  the  thrones,  and  set  upon  them 
golden  dishes;  a  third  mixed  sweet  honeyed  wine  in  a  silver 
bowl  and  distributed  golden  cups;  but  the  fourth  carried  water 
and  lighted  a  great  fire  under  a  large  tripod  and  water  was 
warmed.  But  when  the  water  boiled  in  the  shining  brass,  having 
put  me  in  a  bath,  she  washed  me  and  anointed  me  with  rich  oil. 
She  threw  a  beautiful  cloak  and  garment  about  me  and,  leading 
me  in,  seated  me  on  a  silver-studded  throne,  beautiful,  varie- 
gated; and  a  foot-stool  was  under  my  feet." 

Sir  J.  Floyer,  of  Litchfield,  published  a  book  on  hydrotherapy 
in  London,  in  1697,  that  went  through  six  editions  and  was 
translated  forty  years  later  into  German  and  published  in  Bres- 
lau  and  Leipsic.  The  sixth  edition  was  entitled  ''^i^v^po?.ovGia. 
The  history  of  cold  bathing,  both  ancient  and  modern;  showing 
that  the  present  hydrotherapeutic  treatment  was  successfully 
followed  in  the  seventeenth  and  eighteenth  centuries,  proving 

58 


TYPHOID    FEVEE  59 

its  efficiency,  and  containing  a  variety  of  cases  and  cures  in  gout, 
rheumatism,  consumption,  asthma,  insanity,  fever,  smaU-pox, 
hypochondriasis,  etc.,  together  with  a  few  truisms  for  ah  doctors 
to  think  upon.  Abridged  from  the  fifth  edition,  pubhshed  in  the 
year  1772,  Manchester,  1844." 

Floyer,  on  the  title  page  of  the  first  edition,  added:  "Also 
proving  that  the  best  cures  done  by  the  cold  baths  are  lately 
observed  to  arise  from  the  temperate  use  of  hot  baths  first." 

TYPHOID    FEVER 

The  systematic  use  of  water  in  cases  of  ship  fever  or  typhus 
apparently  dates  from  the  time  of  Dr.  Robert  Jackson,^  who 
used  warm  baths  followed  by  cold  affusions  about  1774.  Dr. 
Wright,  who  practised  in  the  West  Indies,  applied  the  same 
treatment  to  himself  and  a  companion  suffering  on  sliipboard 
about  1777.  In  1797  James  Currie,  an  EngHsh  ship  surgeon, 
advocated  strongly  the  use  of  cold  baths  in  all  cases  of  fever,  and 
practised  it  successfully  on  shipboard.  He  used  affusions  of 
salt  water.  His  writings  influenced  Nathan  Smith,  of  New 
Haven,  who  practised  it  in  1798,  very  shortly  after  its  intro- 
duction by  Currie,  whose  book  was  translated  into  several 
languages.  In  1802  Dimsdale  published  in  London  "An account 
of  cases  of  typhus  fever  in  which  the  affusion  of  cold  water  has 
been  apphed  in  the  London  House  of  Recovery."  Since  that 
time  typhus  and  typhoid  have  been  differentiated. 

The  next  prominent  character  in  hydrotherapy  was  Vincenz 
Priessnitz  (1801-51),  a  farmer  of  Grafenberg,  in  Silesia,  who 
practised  a  crude  method  of  hydrotherapy  with  astonishing  suc- 
cess. His  method  was  to  induce  perspiration  and  then  to  apply 
cold  water  so  as  to  induce  a  reaction.  He  also  made  use  of  the 
cold  compress  known  as  "Priessnitz'  Umschlag" — a  most  valu- 
able application.^ 

1  Robert  Jackson,  Exposition  of  Cold  Affusion  in  Fevers,  1808 . 

2  See  Zur  Wirkung  des  Priessnitzchen  Umschlags  bei  der  Entziindung,  by 
Dr.  H.  Schade,  in  Kiel  Munchener  Medizinischen  Wochenschrift,  No.  18,  1907. 


60  HYDROTHERAPY 

Credit  also  is  due  to  Dr.  Hiram  Corson,  of  Montgomery 
County,  Pennsylvania,  who  for  more  than  fifty  years  treated 
typhoid  fever,  as  well  as  other  infectious  diseases  with  high 
temperature,  by  means  of  cold  baths.  This  remarkable  man, 
\\ho  was  graduated  from  the  University  of  Pennsylvania  in 
1828,  j)ractised  cold-water  bathing,  notwithstanding  the  lack  of 
any  general  sympathy  with  the  method  wliich  has  since  become 
popular,  and  he  obtained  success  even  with  all  the  disadvantages 
attending  country  practice. 

THE  BRAND  TREATMENT 

It,  however,  remained  for  Brand,  of  Stettin,  under  the  title 
"Die  IIydrotherai)ie  des  Typhus,"  published  in  1861,  to  jiopu- 
larize  this  invaluable  method  of  treatment.  There  are  various 
modifications  of  Brand's  method  which  will  be  referred  to  later. 

It  is  a  mistake  in  treating  fevers  by  hydrotherapy  to  ajiply 
very  low  temperatures,  very  slight  mechanical  stimuli,  and  only 
for  a  short  period.  Such  applications,  according  to  Winternitz, 
raise  the  temperature  instead  of  reducing  it.  Long  cool,  not 
cold,  baths,  rather  intensive  mechanical  stimuli,  trantjuil  rest 
under  adequate  covering  after  such  a  bath,  and  its  repetition  at 
the  proper  time  are  the  necessary  factors.  By  paying  attention 
to  the  body  temperature  alone  the  physician  is  apt  to  err  by  too 
frequent  and  too  cold  baths  in  the  severe  infectious  diseases. 

In  this  manner  nervous  disturbances  may  be  engendered, 
but  by  longer  intervals,  slightly  warmer  water,  and  longer  baths 
these  complications  are  avoided.  In  typhoid  a  very  dicrotic 
and  rapid  pulse  is  more  important  as  an  indication  for  repeating 
the  baths  than  a  high  temperature.  Very  rapid  pulse  with  a  still 
vigorous  heart  calls  for  wet  packs,  repeatedly  changed,  which 
in  case  of  a  slow  pulse  and  signs  of  weakness  on  the  part  of  the 
heart  would  be  a  serious  blunder. 

The  behavior  of  the  blood-vessels  is  the  guide  for  the  choice  of 
the  temperature  and  for  the  length  and  degree  of  the  mechanical 
stimulation.  When  the  vessels  display  a  paralytic  tendency, 
the  most  energetic  thermic  stimulation  is  demanded  with  avoid- 


THE    BRAND   TREATMENT 


61 


ance  of  much  mechanical  stimulation  of  the  skin.     This  may  be 
accomplished  by  brief  dips  and  douches  of  quite  cold  water.^ 

Alcohol. — Although  Brand  himself  advocated  it,  there  is 
some  difference  of  opinion  as  to  the  value  of  alcohol  given  before 
and  after  the  Brand  bath  in  typhoid  fever.  J.  C.  Wilson,  Tyson, 
Musser,  Stengel,  W.  Oilman  Thompson,  and  others  generalty 
employ  it.  The  best  time  is  twenty  minutes  before  the  bath,  so 
as  to  allow  for  absorption.  Winternitz  gives  a  single  mouthful 
of  wine.  It  has  been  urged,  however,  that  nervous  sensibility 
is  lessened  by  its  use,  and  the  effect  of  the  bath  on  the  nervous 


Fig.  17. — Wheeled  tub  (An  American  Text-book  of  Applied  Therapeutics). 

system  is  to  that  extent  reduced.  In  other  words,  their  effects 
are  antagonistic.  It  is  probable  that  the  theoretic  objections 
to  the  use  of  alcohol  under  these  circumstances  are  not  of  practi- 
cal importance,  for  clinical  experience  does  not  seem  to  justify 
the  objection. 

Dr.  James  Tyson's  rules  for  use  in  the  Hospital  of  the 
University  of  Pennsylvania  in  typhoid  cases  are  as  follows : 

x4bsolute  rest  in  bed.  Milk  diet  as  prescribed  by  the  physi- 
cian in  charge.  Patient  must  be  encouraged  to  void  urine  before 
the  bath. 

^  W.  Winternitz,  Missgriffe  bei  Wasserkuren,  in  Berliner  klin.  Woch.,  April 
3,  1905. 


62  HYDROTHERAPY 

Cover  loosely  with  a  sheet  ami  gently  lift  the  patient  into  the 
tub,  which  is  placed  alongside  the  bed.  Temperature  of  the 
water  usually  70°  F.  (21°  C).  Always  have  an  air-cushion  upon 
which  to  rest  the  head;  during  the  bath  rub  the  i)atient  briskly 
in  order  to  keep  up  good  circulation.  A  compress  of  iced  water  or 
an  ice-cap  is  kept  on  the  head.  At  the  end  of  fifteen  minutes  lift 
the  patient  into  bed.  Dry  and  lay  between  blankets  for  fifteen 
minutes.  As  soon  as  the  [)atient  ceases  to  shiver — usually 
within  fifteen  or  twenty  minutes — take  the  temperature.  The 
temperature  is  not  taken  again  until  three  hours  after  the  bath. 
If  it  is  then  102.2°  F.  (39°  C.)  or  above,  the  bath  is  repeated. 
If  the  temperature  is  102°  F.  (38.9°  C.)  or  below,  but  above 
101°  F.  (38.3°  C),  it  is  taken  again  in  one  hour;  if  below  101°  F. 
(38.3°  C.)  and  above  100°  F.  (37.8°  C),  taken  in  two  hours;  and 
if  below  100°  F.  (37.8°  C),  it  is  taken  in  three  hours.  But 
whenever  the  temperature  reaches  102.2°  F.  (39°  C.)  the  bath 
is  given,  provided  three  hours  have  elapsed  since  the  last  bath. 
Eight  baths  may  be  given  in  twenty-four  hours. 

The  normal  effect  of  a  cold  bath  is  a  reduction  of  2°  F. 
(1.1°  C).  The  nurse  must  watch  the  patient's  face  and  take 
the  pulse  frequently  while  in  the  bath.  In  addition  to  the 
lowered  temperature,  the  immediate  effect  of  the  bath  is  to  add 
strength  to  the  heart  and  to  increase  the  volume  and  slow  the 
rate  of  the  pulse. 

In  sponging,  a  thin  film  of  water  should  be  kept  on  the  surface 
sponged,  for  it  is  the  evaporation  of  this  which  is  effectual  in 
cooling  the  body.  If  the  patient  be  constipated,  a  simple  enema 
should  be  given  every  other  day. 

Hemorrhage  demands  absolute  quiet,  cold  by  means  of  ice 
to  the  abdomen,  a  minimum  amount  of  food,  and  elevation  of 
the  foot  of  the  bed. 

Dr.  J.  M.  Anders,  at  the  Medico-Chirurgical  Hospital,  Phila- 
delphia, when  using  baths  in  typhoid  fever,  usually  keeps  the 
patient  in  the  bath  at  first  for  only  five  or  ten  minutes;  later, 
ten  or  fifteen  minutes,  according  to  the  severity  of  the  case. 
The  head  and  face  are  bathed  from  a  basin  and  a  cold  compress 


THE   BRAND   TREATMENT  63 

is  applied  to  the  forehead  at  the  start.  If  prominent  nervous 
symptoms  are  present,  often  associated  with  high  temperatm-e, 
water  at  70°  F.  (21.1°  C.)  or  lower  should  be  poured  from  an 
elevation  of  about  6  inches  upon  the  head  and  nape  of  the  neck 
several  times  during  the  bath.  The  ears  must  be  stopped  with 
cotton  while  douching  is  practised.  In  obstinate  and  severe 
cases  in  which  the  fall  of  temperature  may  be  less  than  1  degree, 
Dr.  Anders  sometimes  prolongs  the  bath  to  twenty  minutes,  or 
still  further  reduces  the  temperature  of  the  water.  In  light 
cases  the  cold  bath  should  be  repeated  every  six  or  eight  hours; 
in  severe  ones,  every  three  or  four  hours,  but  oftener  than  this 
is  not  advisable,  even  in  the  worst  cases.  The  patient  should 
be  allowed  to  sleep  at  night  if  possible.^ 

Dr.  Alfred  Stengel's  rules  for  use  in  the  Hospital  of  the 
University  of  Pennsylvania  for  typhoid  cases  are : 

Temperature,  pulse,  and  respiration  every  three  hours. 
Sponge  at  temperature  of  101.2°  F.  (38.5°  C).  Bath  at  102.4°  F. 
(39.1°  C).  Have  the  temperature  of  the  water  70°  F.  (21.-1°  C). 
Ice-caps  to  head  continually.  Simple  enema  every  other  day  if 
necessary.  The  tub  is  used  only  in  cases  of  typhoid  which  begin 
with  some  definiteness  of  symptoms.  Those  that  begin  in  a 
very  mild  way  are  not  usually  tubbed,  but  only  in  case  of  some 
manifestation.  If  the  patient  is  very  nervous  or  the  bath  is 
not  well  borne,  they  are  discontinued.  No  children  are  bathed 
according  to  the  Brand  method,  and  baths  are  not  given  during 
menstruation. 

Dr.  Musser's  rules  are: 

Temperature,  pulse,  and  respiration  every  two  hours.  Sponge 
at  a  temperature  of  102°  F.  (38.9°  C).  Tub  at  103°  F.  (39.5°  C). 
Have  temperature  of  the  water  80°  F.  (26.7°  C).  Reduce  to 
70°  F.  (21.1°  C). 

.  Milk  (oiv)  with  lime-water  (oss)  every  two  hours.  Ice-cap  to 
head  continually.  Take  temperature  during  the  bath  or  imme- 
diately after,  and  again  in  fifteen  minutes. 

As  a  rule,  the  patient  should  be  lifted  into  the  tub,  but  very 

1  J.  M.  Anders,  Practice  of  Medicine,  ninth  ed.,  1909. 


64 


HYDROTHERAPY 


heavy  patients,  if  their  conditions  warrant  it,  may  step  from  the 
bed  into  the  tub  close  at  hand.  Some  permit  the  patient  to 
walk  a  little  way  to  the  tub,  but  this  is  a  needless  risk. 

The  Tub. — A  good  portable  tub  has  been  made  according  to 
Dr.  Baruch's  design.  It  has  the  advantages  of  allowing  the 
patient's  legs  to  be  flexed  as  he  lies  in  the  tub,  the  feet  resting 
against  a  double  bottom  which  is  filled  with  warm  water  intro- 
ducetl  through  a  tube  with  a  funnel-shaped  opening  near  the 
upper  margin.     The  water  is  drained  off  through  the  lower  faucet. 


Fig.  18. — Hospital  bath-tub  with  elevator  stretcher. 


The  tub  itself  is  filled  with  colder  water.  This  style  of  tub  is  com- 
fortable to  the  patient  and,  being  higher,  enables  the  nurses  to 
handle  him  more  easily  and  work  to  better  advantage.  It  is  also 
shorter  and  lighter  than  the  ordinary  tub.     (See  also  p.  66.) 

There  are  cases  of  typhoid  fever  with  evidence  of  profound 
toxemia,  but  in  which  the  temperature  is  below  102.5°  F. 
(39.2°  C).  Tepid  and  warm  or  even  hot  (104°  F.— 40°  C.) 
full  baths  are  then  indicated  and  friction  should  be  applied. 
In  this  way  there  is  a  better  chance  to  restore  circulatory  equilib- 
rium, reduce  the  toxemia,  and  favor  a  restoration  to  the  normal 


THE    BRAND    TREATMENT  65 

temperature  of  the  body.  H.  A.  Hare  has  always  favored 
substitutes  for  the  Brand  method  since  his  personal  experience 
with  typhoid  fever  in  1900,  and  there  is  an  evident  trend  of 
opinion  away  from  tubbing  and  in  favor  of  sponging  and  other 
substitutes,  unless  the  temperature  rises  above  102.5°  or 
103°  F.  (39.2°  or  39.5°  C). 

Important  Guides  Besides  the  Thermometer. — ^^Vhile  it 
seems  necessary  to  formulate  certain  rules  as  to  tubbing,  espe- 
cially in  hospital  practice,  it  must  not  be  forgotten  that  there  are 
important  guides  besides  the  thermometer;  for,  as  Oilman 
Thompson  says,  this  instrument  only  records  the  average  or 
temporary  balance  of  heat  gain  and  loss.  Excessive  heat  pro- 
duction, if  accompanied  by  proportionally  rapid  heat  loss,  may 
give  a  low  thermometric  record,  and  j^et  the  obscure  abnormal 
metabolism  producing  the  increase  in  heat  may  be  working  great 
havoc  within  the  body.  This  fact  may  in  some  degree  account  for 
the  exceptionally  rapid  emaciation  in  a  certain  class  of  cases  in 
which  the  thermometric  record  remains  low  throughout ;  for 
heat  production  in  the  body  is  mainly  due  to  chemic  processes, 
its  loss,  to  physical  processes.* 

During  the  Franco-Prussian  War  a  large  number  of  fatalities 
from  typhoid  fever  were  reported  in  a  series  of  cases  in  which  the 
temperature  did  not  reach  102°  F.  (38.8°  C). 

Rubbing, — The  intense  involvement  of  the  nervous  system 
in  severe  cases  is  shown  by  the  early  headache  and  disturbance 
of  special  senses;  by  restlessness  and  insomnia  and  the  delirium; 
subsultus,  tremor,  and  the  whole  train  of  familiar  symptoms. 
It  is  here  that  sudden  cold  and  vigorous  rubbing  are  demanded. 
Indeed,  rubbing  may  be  the  keynote  to  the  whole  system  of  tub- 
bing. For  the  full  use  of  rubbing  Thompson  prefers  a  full  bath- 
tub, so  that  the  patient  may  float  and  all  surfaces  of  the  body 
be  easily  accessible. 

The  Cold  Bath. — Liebermeister,  of  Basel,  over  forty  years 
ago  advocated  the  lukewarm  hath  at  90°  F.  (32.2°  C),  gradually 
cooled,  but  this  missed  the  valuable  stimulating  effect   on  the 

1 W.  Gilman  Thompson,  Trans.  New  York  State  Med.  Assoc,  1902. 
5 


66 


HYDROTHERAPY 


nervous  system  and  the  vigorous  reaction  which  is  tho  real  aim 
of  the  Brand  bath  properly  administered.  "It  is  the  energetic 
friction  which  prevents  shivering,  keeps  the  skin  in  good  condi- 
tion, determines  more  blood  to  the  peripheral  vessels,  and  helps 
to  divert  the  patient's  mind  from  discomfort.     A  feature  of  no 


Fig.   19. — Portable   bath-tub:    A,    Open,    ready  for  use:  B,  folded,  for  transporta- 
tion (An  American  Text-book  of  Applied  Therapeutics).' 

little  importance  is  the  increased  depth  of  respiration  obtained 
throughout  the  cold  plunge  bath,  which  antagonizes  the  tend- 


1  A  good  folding  bath-tub  is  made  by  Russell  M.  Irwin,  103  Chambers 
Street,  New  York,  at  a  moderate  price.  A  good  portable  and  folding  bath-tub 
has  been  invented  by  Dr.  C.  L.  Furbush. 


THE   BRAND   TREATMENT 


67 


ency  to  pulmonary  congestion  and  bronchial  catarrh.  As  a 
more  remote,  but  no  less  important,  effect  the  digestion  improves 
and  nutrition  is  maintained,  so  that  extreme  emaciation  is  rare; 
bed-sores  and  general  furunculosis  are  practically  unknown,  the 


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Fig.  20. — Temperature-chart  of  a  case  of  enteric  fever  treated  with  cold  baths 
and  terminating  in  recovery.  The  black  dots  show  the  influence  of  the  individual 
baths  upon  the  temperature  (An  American  Text-book  of  Applied  Therapeutics). 


mind  clears,  the  sensation  of  muscular  soreness  is  alleviated,  and 
the  entire  morale  of  the  patient  is  benefited.  Such  are  the  real 
advantages  of  treatment  by  cold  tub-baths,  and  the  fact  should 
be  emphasized  that  the}''  may  all  be  obtained  through  the  stimu- 


68  HYDROTHERAPY 

lation  of  the  nervous  system,  even  without  immediate  lowering  of 
the  thermometric  record. 

"  In  every  considerable  group  of  typhoid  fever  cases  are  a  few 
in  wliich  the  cold  tub-bath  fails  to  reduce  the  body  temperature, 
and  I  have  seen  it  even  rise  a  little  after  a  bath,  while  the  patient 
showed  marked  improvement  in  other  respects.  I  have  records 
of  cases  in  which  sponge  baths  produced  as  decided  an  effect 
upon  the  temperature  alone  as  did  subsequent  "tubbing,"  but 
I  have  yet  to  see  one  in  which  their  effect  exceeded  that  of  tub- 
bing, and  in  the  great  majority  of  cases  they  fall  far  short  of  it  in 
every  way." 

Dr.  Thompson's  practice  is  to  employ  the  tub-bath  at  75°  F. 
(23.9°  C.)  for  fifteen  minutes  whenever  the  patient's  temperature 
reaches  or  exceeds  102.5°  F.  (39.2°  C),  and  to  insist  on  gentle 
but  continuous  friction  of  the  skin  by  two  nurses  during  the 
entire  bath. 

"Experience  has  taught  the  advantage  of  attention  to  detail 
in  the  treatment  and  the  fallacy  of  rigid  rules.  Not  a  few  patients 
do  better  with  a  bath  of  eight  or  ten  minutes'  duration  than  in 
one  of  fifteen  minutes,  or  they  may  do  better  with  water  at  80°  F. 
(26.7°  C.)  than  at  75°  F.  (23.9°  C).  Alcoholic  stimulation 
should  be  given  fully  twenty  minutes  before  the  bath,  to  admit 
of  its  absorption  before  the  cold  is  applied — a  matter  of  no  little 
importance.  Shivering  is  less  if  the  back  be  rubbed  first,  and 
the  tub  should  be  large  enough  and  full  enough  to  admit  of 
readily  floating  the  patient;  on  no  account  should  he  be  left  to 
shiver  for  several  minutes  in  the  tub  while  the  nurse  is  preparing 
the  bed  for  his  return;  he  should  be  promptly  and  thoroughly 
dried  when  taken  out  of  the  tub  and  immediately  left  alone  to 
sleep.  These  may  appear  trivial  details,  but  anyone  who  has  had 
personal  experience  in  the  tub  realizes  that  they  are  not  so,  and 
they  are  often  overlooked  by  those  who  state  that  they  have 
applied  this  method  of  treatment,  but  gave  it  up  on  account  of 
the  patient's  discomfort.  I  have  met  with  far  more  complaint 
of  the  discomfort  of  cold  sponge  baths  than  tubbing  among 
patients  who  have  submitted  to  both. 


THE    BRAND   TREATMENT  69 

''No  one  claims  that  cold  tubbing  'cures'  typhoid  fever  or 
even  aborts  it,  but  it  unquestionabl}^  fortifies  the  nervous  system 
against  the  factors  of  the  disease,  and  enables  the  patient  to 
endure  what  is  at  best  a  long  and  tedious  siege  with  very  much 
less  misery.  The  only  indications  for  its  suspension  are  the  oc- 
currence of  hemorrhage  or  pneumonia,  when  cold  sponging  should 
be  substituted.  The  method  most  emphatically  does  not  induce 
hemorrhage,  or  produce  relapse,  or  cause  neuritis,  or  any  other 
serious  compHcation,  as  has  been  claimed  against  it.  Its  justi- 
fication is  shown  in  the  remarkable  unanimity  of  the  hospital 
records  throughout  the  country,  which  show  a  mortality  among 
thousands  of  cases  averaging  from  7  to  7.5  per  cent,  in  each 
institution  where  the  treatment  has  been  faithfully  carried  out  for 
years,  as  against  a  previous  death-rate  of  double,  often  triple, 
that  figure. 

"Enthusiasm  for  hydrotherapy  should  not  lead  one  to  de- 
prive the  patient  of  sufficient  rest,  and  except  in  cases  of  a  tem- 
perature protracted  in  the  neighborhood  of  105°  F.  (40.6°  C), 
it  is  best  to  omit  at  least  one  of  the  three  hourly  baths  at  night, 
and  if  desirable  to  give  a  mild  hypnotic." 

The  number  of  baths  given  in  a  single  case  may  reach  the 
extraordinary  number  of  175.  This  record  was  made  by  Kin- 
nicutt  in  a  case  of  such  exceptional  gravity  and  hopelessness  that 
the  question  of  discontinuing  the  baths  was  discussed;  but  it 
Vv^as  decided  to  continue  them.  The  patient  made  a  good  recov- 
ery.i 

It  cannot  be  too  often  reiterated  that  the  main  object  of  the 
cold  bath  in  typhoid  fever  or  in  any  other  febrile  disease  is  7iot 
the  reduction  of  temperature.  The  antipyretic  quality  of  the 
cold  bath,  cold  affusion,  or  cold  spray  is  entirely  subordinate  to 
the  general  effect  on  the  nervous  sj^stem,  the  heart,  the  lungs,  the 
blood,  and  its  circulation.  The  cold  bath  cannot  be  considered 
alone  without  the  all-important  friction,  the  sine  (jua  non  of  the 
cold  bath.     Even  in  such  a  serious  affection  as  sunstroke,  in 

-  See  the  Treatment  of  Typhoid  Fever  by  Cold  Baths,  by  George  Wilkins, 
M.  D.,  Trans.  Association  of  American  Physicians,  1892. 


70  HYDROTHERAPY 

which  it  is  highly  essential  that  body  temperature  be  reduced, 
the  good  effect  of  the  use  of  cold  water  in  the  form  of  sprinkling 
and  cold  affusions  is  accomplished  only  by  the  vigorous  stimula- 
tion of  the  nerve  centers,  inducing  an  added  power  to  withstand 
the  toxemia. 

Brand  summed  up  the  benefits  observed  by  him  in  typhoid 
by  stating  that  the  good  effects  of  the  bath  are  seen  not  only  in  the 
reduction  of  excessive  temperature,  but  also  in  a  clearing  of 
the  intellect,  a  lessening  of  the  stupor,  a  disappearance  of  the 
muscular  twitching,  a  general  tonic  influence  upon  the  nerves, 
and  especially  upon  the  heart  and  lungs,  in  an  improvement  of  all 
of  the  bodily  functions,  in  the  promotion  of  sleep,  and,  finally, 
in  a  reduction  of  the  mortality.  As  a  rule,  no  medication  is  re- 
quired, and  the  use  of  alcohol  is  not  necessary,  except,  perhaps,  in 
those  who  have  been  accustomed  to  it.  If  constipation  be  pres- 
ent at  the  beginning,  an  initial  full  dose  of  calomel  (gr.  v)  may 
be  administered.  In  the  course  of  the  attack  simple  enemata 
may  be  employed. 

The  hydriatric  treatment  of  typhoid  fever  may  be  employed 
at  any  stage  of  the  disease  and  at  any  period  of  life.  The  best 
results  are  naturally  secured  the  earlier  in  the  attack  the  patient 
is  placed  under  treatment.  In  cases  coming  under  observation 
and  submitted  to  the  treatment  prior  to  the  fifth  day,  death  may 
be  entirely  averted.  Not  all  children  bear  the  full  cool  bath 
well.  In  patients  past  sixty,  it  is  best  to  use  the  gradually 
cooled  bath,  the  water  being  at  first  about  10°  F.  (5.4°  C.) 
lower  than  the  temperature  of  the  body,  and  being  gradually 
reduced  in  the  course  of  from  twenty  to  thirty  minutes  to  68°  F. 
(20°  C).  The  only  compUcations  that  interdict  the  continu- 
ance of  the  baths  are  intestinal  perforation,  peritonitis,  and 
free  hemorrhage.  Experience  shows,  however,  that  complica- 
tions are,  in  general,  less  common  in  those  treated  according  to 
the  Brand  plan  than  in  those  treated  by  any  other  method.' 

Counterindications. — On  the  whole,  it  may  be  said  that  the 

*  See  also  Some  Considerations  of  the  Treatment  of  Typhoid  Fever,  by 
A.  A.  Eshner,  M.  D..  Medical  News,  Sept.  19,  1896. 


SUBSTITUTES  FOR  THE  BRAND  METHOD  71 

Brand  bath  is  not  well  borne  by  the  very  young  or  very  old,  and 
in  patients  who  come  under  treatment  as  late  as  the  third  week. 
It  is  then  rather  difficult  to  get  a  good  reaction.  When  the 
patient  fails  to  react,  it  is  a  good  plan  to  use  tepid  or  hot  water 
to  redevelop  the  reactive  power.  The  presence  of  complicating 
pneumonia  is  generally  held  to  counterinclicate  the  Brand  bath. 
It  should  be  added  in  connection  with  bathing  in  typhoid 
fever  that  renal  complications  should  not  be  deemed  a  counter- 
indication.  Physicians  differ  in  their  practice  as  to  baths  during 
menstruation. 

SUBSTITUTES  FOR  THE  BRAND  METHOD 

A  common  practice  in  typhoid  fever  is  to  apply  an  ice-cap  to 
the  head  when  the  patient's  temperature  reaches  101°  F. 
(38.3°  C);  cool  sponging  at  102°  F.  (38.9°  C),  and  a  tub-bath  at 
70°  F.  (21.1°  C.)  when  the  temperature  is  103°  F.  (39.5°  C.)  or 
over. 

The  Warm  Full  Bath. — This  has  been  ardently  advocated 
by  Dr.  Riess,  of  Berlin,  who  reports  809  cases  of  typhoid  fever 
treated  with  baths  of  88°  F.  (31.1°  C.)  for  several  hours  at  a  time. 
When  the  temperature  of  the  patient  reaches  102°  F.  (38.9°  C.) 
he  is  allowed  to  remain  in  the  bath  until  the  rectal  temperature 
reaches  100°  F.  (37.8°  C).  This  may  require  from  five  to  ten 
hours,  and  the  procedure  is  repeated  as  often  as  the  fever  re- 
quires. Its  success  in  Dr.  Riess'  hands  was  shown  by  a  reduc- 
tion in  mortality  from  the  previous  record  of  10  per  cent,  to 
8J  per  cent.  Although  the  reduction  was  not  over  15  per  cent, 
of  the  previous  mortality,  the  shortening  in  the  duration  of  the 
disease  was  very  noticeable  and  its  best  feature.  It  does  not 
reduce  temperature  rapidly,  its  efficacy  is  not  so  great  as  by  the 
Brand  method,  but  it  is  a  fair  substitute. 

Ice  Rubbing. — One  of  the  best,  simplest,  and  most  rational 
substitutes  for  the  Brand  bath  in  typhoid  is  ice  rubbing.  The 
ice  to  be  used  should  have  a  flat  surface  and  be  held  in  gauze. 
The  rubbing  should  be  begun  with  the  hmbs  and  finished  with 
the  trunk,   exposing  only  the    portion    being  rubbed.     Active 


72 


HYDROTHERAPY 


friction  is  required  to  bring  the  blood  to  the  surface,  and  a  suc- 
cessful and  effective  ice  rub  requires  a  good  nurse,  quite  as  good 
as  in  giving  a  Brand  bath. 


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Fig.  21. — Ice  rubbing  in  typhoid  fever. 

Dr.  Hobart  A.  Hare,  who  has  used  this  method  exclusively 
for  ten  years,  has  kindly  furnished  the  author  with  a  chart 
showing  the  effect  of  ice  rubbing  in  a  case  of  typhoid  fever. 
Eighty-one  ice  rubs  were  used  in  the  course  of  four  weeks.     The 


SUBSTITUTES  FOR  THE  BRAND  METHOD 


73 


chart  shows  a  fall  of  temperature  of  from  2°  to  4°  F.  (1.1°- 
2.2°  C.)  after  the  ice  rubs;  and  usually,  also,  a  slight  reduction 
in  the  pulse-rate  and  a  general  subsidence  of  the  disease. 

The  results  of  ice  rubbing  are  identical  with  those  of  the 
Brand  bath  because  the  same  principles  are  applied.  There  is 
the  same  impression  upon  the  nervous  system  and  circulation. 

Ice  rubbing  is  used  sometimes  in  connection  with  sprink- 
ling. 


Fig.  22. — Ice  rubbing  and  sprinkling.     Cot  should  be  elevated  at  the  head  (Cohen). 

When  hemorrhage  is  a  complication  of  typhoid  fever,  an  ice- 
bag  or  an  ice-poultice  should  be  applied  to  the  abdomen.  (See 
pp.  349  and  355.) 

Sponging  with  cool  water  is  widely  preferred  instead  of  the 
Brand  bath,  and  commonly  adopted  when  the  temperature 
reaches  101°  or  102°  F.  (38.3°  or  38.9°  C).  As  mentioned 
previously,  sponging  is  relied  upon  at  these  more  moderate 
temperatures  and  the  Brand  treatment  is  reserved  until  the 
fever  rises  to  102.4°  or  103°  F.   (38°  or  39.5°  C).     In  Eng- 


74  HYDROTHERAPY 

lish  hospitals  sponging  is  generally  relied  upon  exclusively. 
The  author  recently  visited  Guy's,  St.  Thomas',  and  St.  George's 
hospitals,  and  found  that  sponging  was  the  only  hydriatric 
method  employed.  Typhoid  fever  is,  however,  fortunatel)% 
more  rare  in  England  than  in  the  United  States.  (For  the 
Technic  of  Sponging,  see  p.  248.) 

Investigation  shows  a  marked  change  in  the  practice  of  bath- 
ing in  typhoid  among  Continental  physicians.  This  was  sum- 
marized recently  in  "Excerpta  Medica"  (Leipsig,  edited  by  E. 
Graetzer),  in  a  symposium  on  the  Treatment  of  Typhoid  Fever, 
to  which  Eichhorst,  von  Striimpell,  F.  Schultze,  Romberg, 
Erb,  and  others  contributed.'  They  all  agree  as  to  the  useful- 
ness of  Brand's  method  with  certain  modifications,  especially 
when  there  is  marked  disturbance  of  the  sensorium  or  of  the 
respiratory  or  circulatory  systems. 

The  following  general  statements  may  be  made: 

1.  None  bathe  at  night,  between  the  hours  of  8  p.  m.  and  6 

A.  M. 

2.  With  but  one  exception,  no  one  tubs  unless  the  tempera- 
ture is  over  103°  F.    (39.4°  C). 

3.  Nearly  every  one  uses  the  graduated  bath,  beginning  about 
90°  to  95°  F.  (32.2°-35°  C.),  and  very  gradually  cooHng  to 
rarely  lower  than  80°  F.  (26.6°  C). 

4.  But  one  or  two  ever  exceed  three  baths  daily,  and  nearly 
all  speak  of  one  or  two  baths  as  all  that  are  necessary  in  the  great 
majority  of  cases. 

5.  Short  baths,  without  apparently  any  special  regard  to  the 
reduction  of  temperature,  appear  to  be  most  in  favor.  Many 
speak  of  ten  to  fifteen  minutes'  duration,  some  of  five  to  ten 
minutes,  and  a  few  say  simply  "short." 

In  view  of  the  interest  and  importance  of  the  subject,  a  few 
quotations  may  perhaps  be  made : 

Weintraub  says  "that  unless  the  patient  feels  and  appre- 
ciates the  benefit  of  the  cold  bath,  it  is  a  'torture'  which  is  ac- 
tually injurious."     Korach  says,  "Forced  bathing  is  horrible, 

1  Editorial,  Colorado  Medicine,  May,  1909. 


SUBSTITUTES  FOR  THE  BRAND  METHOD  75 

and  injurious  in  severe  cases."  Grunert,  a  pupil  of  Liebermeis- 
ter,  says  that  "Systematic  cold  bathing  is  horrible."  "Luke- 
warm baths  of  90°  to  94°  F.  (32.2°-34.4°  C.)  are  desirable  and 
sufficient  for  most  cases,"  is  the  conclusion  of  Eichhorst.  Len- 
hartz  recommends  "92°  F.  (33.3°  C.)  of  five  to  ten  minutes' 
duration,  for  the  most  part,  twice  daily."  According  to  Schulze, 
"Their  unremitting  apphcation  is  barbarous."  Prof.  Umber 
says,  "  We  bathe  most  cases  only  once  a  day."  Erb,  one  of  the 
few  who  are  still  ardent  apostles  of  the  Brand  method,  says,  "It 
is  not  an  antifebrile  meassure";  he  bathes,  therefore,  in  all  cases, 
but  in  the  lightest  only  once  daily,  and  in  the  moderate,  twice, 
for  ten  to  fifteen  minutes  in  a  bath  gradually  reduced  from  95  ° 
to  75°  F.  (35°-23.8°  C).  According  to  von  Striimpell,  "One  or 
two  baths  daily  mostly  suffice ;  it  is  most  earnestly  warned  against 
excesses."  And,  finally,  Romberg  writes  as  follows:  "In  the 
use  of  tubbing  we  cannot  be  guided  by  the  temperature,"  having 
before  emphasized  the  supreme  importance  of  the  condition  of 
the  sensorium  and  of  the  respiratory  organs  as  an  indication. 
"For  the  most  part,  one  or  two  a  day  are  enough,"  and  "we 
prefer  not  to  go  below  a  temperature  of  85°  F.  (29.4°  C). 

Sprinkling  is  a  good  substitute  for  the  Brand  bath  and  is 
often  better  borne;  it  certainly  is  more  easily  carried  out  and  has 
many  advocates. 

The  head  of  the  bed  is  first  raised  10  or  12  inches  from  the 
floor.  Three  boards  as  long  as  the  bed  is  wide  are  placed  cross- 
wise under  the  mattress  to  keep  it  from  sagging.  A  rubber  sheet 
covered  with  a  linen  one  is  placed  under  the  patient,  whose 
head,  wrapped  in  a  cool  wet  turban,  rests  on  a  pillow.  The 
night-dress  is  removed,  and  the  water,  at  a  temperature  10  or 
12  degrees  cooler  than  would  ordinarity  be  used  in  the  bath,  is 
applied  from  a  sprinkling  pot  or  from  an  irrigating  apparatus 
provided  with  a  large  rose  nozzle.  Active  friction  is  kept  up  as 
in  the  Brand  bath.  Some  practitioners  use  a  dry  linen  sheet 
over  the  patient  and  sprinkle  this  with  ice-water,  using  friction. 
The  water  should  come  from  a  height  of  2  or  3  feet  and  should  be 
directed  chiefly  to  the  abdomen  and  lower  extremities.     The 


76  HYDROTHERAPY 

surplus  water  should  be  allowed  to  drain  into  a  pail  or  tub.  The 
patient  is  then  wrapped  in  a  dry  sheet,  covered  with  a  blanket, 
and  rubbed.  The  process  is  repeated  as  in  the  directions  for  the 
Brand  bath.      (See  p.  60.) 

The  wet  cold  pack  is  another  substitute,  but  its  application 
is  more  exhausting  to  the  patient  than  sprinkling,  for  it  has  to  be 
renewed  more  frequently.  Dr.  Anders  finds  this  method  of 
great  use  in  children.     (For  Teclinic,  see  p.  340.) 

The  sheet  bath  (Lakenbad,  of  Strasser)  is  preferable  as  a 
substitute  for  the  Brand  bath.  The  linen  sheet  is  soaked  in 
water  at  from  50°  to  80°  F.  (10°-26.7°  C),  as  may  be  desired. 
The  head  and  face  of  the  patient  are  bathed  in  iced  water  and  a 
cool  wet  turban  is  wrapped  around  the  head.  The  bed  is  pro- 
tected by  a  rubber  sheet  on  which  is  placed  the  wet  sheet  partly 
wrung  out.  The  patient  is  now  placed  upon  the  wet  sheet,  and, 
while  his  hands  are  held  above  his  head,  one  side  of  the  sheet  is 
laid  over  the  chest  close  under  the  axilla  and  bej'^ond  the  axillary 
line  of  the  opposite  side,  and  folded  in  between  his  legs.  The 
arms  are  now  brought  down  and  the  opposite  side  of  the  sheet  is 
then  passed  across  the  body  and  snugly  fitted  in  place,  covering 
the  arms  and  shoulders  and  tucked  under;  the  lower  end  is 
tucked  under  the  heels. 

The  nurse  should  rub  the  body  thus  enveloped  and  should 
pour  cups  of  water  at  50°  or  60°  F.  (10°  or  15.6°  C.)  as  the  sheet 
warms,  and  commence  rubbing  again.  This  is  continued  until 
the  patient  feels  cold  or  shivers  cjuite  perceptibly.  More  friction, 
how^ever,  will  obviate  this.  He  may  lie  in  pack,  if  comfortable, 
for  half  an  hour,  the  rubber  sheet  being  withdrawn  and  a  blanket 
substituted. 

The  wet  cold  pack  should  be  employed  where  tubs  are  not  to 
be  had  or  when  tub-baths  are  opposed.     (See  p.  340.) 

Ice -water  enemata  may  be  tried  in  desperate  cases. 

Hot  Sponging. — Thif*  substitute  for  bathing  sometimes  yields 
excellent  results  when  the  patient  is  very  nervous,  or  when,  for 
any  other  reason,  Brand  baths  cannot  be  given.  The  water 
should   be  at  about   110°  or  112°  F.  (43.3°  or  44.4°  C);  in 


SUBSTITUTES  FOR  THE  BRAND  METHOD  77 

another  receptacle  containing  water  at  about  100°  F.  (37.8°  C.) 
place  a  2-ounce  bottle  of  grain  alcohol. 

Sponge  the  limbs  separately  and  then  the  body  for  ten  min- 
utes, and  finish  with  a  quick  general  rubbing  with  the  warm  al- 
cohol. This  is  an  excellent  method,  especially  for  children.  The 
temperature  of  the  water  and  alcohol  may  be  lowered  and  its 
strength  varied  as  judgment  and  experience  with  the  patient 
may  indicate.  The  alcohol  sponge  may  be  tempered  to  suit 
the  feelings  of  the  patient  and  the  strength  may  vary  from  25 
to  95  per  cent. 

Oil  Inunctions. — Among  other  substitutes  for  bathing,  used 
with  great  success  when  cold  applications  cannot  be  given,  are 
inunctions  of  oil.  Although  they  are  not  hydrotherapeutic 
measures,  they  are  mentioned  here  because  cases  have  arisen 
and  will  be  met  with  in  which  the  external  use  of  cold  must  be 
discontinued  owing  to  the  extreme  depression  and  shock  it 
produces. 

After  inunctions  of  oil  the  patient  is  more  comfortable,  the 
temperature  is  slightly  reduced,  and  sleep  is  favored.  There 
seems  to  be  less  waste  and  prostration.^ 

Conclusions. — ^As  far  as  substitutes  for  the  Brand  bath  are 
concerned,  we  need  more  extensive  statistics  of  the  results  of 
treatment  by  sponges,  ice  rubbing,  etc.  Elaborate  reports  are 
accessible  in  reference  to  baths,  and  we  acknowledge  the  good 
results  obtained.  Dr.  McCrae  ^  says  of  the  substitutes  for  Brand 
baths:  "They  have  no  marked  influence  on  the  general  condi- 
tion, and  while  they  give  comfort  and  are  undoubtedly  helpful, 
their  effect  is  in  no  way  to  be  compared  to  that  which  follows 
hydropathy  in  the  form  of  baths." 

Much  of  the  benefit  of  hydrotherapy  is  attributed  to  the 
greatly  increased  excretion  of  toxins.  One  of  the  errors  which 
most  of  us  are  still  laboring  under  is  our  attitude  with  reference 
to  the  presence  of  fever  and  a  failure  to  recognize  its  remedial 

1  See  John  H.  Musser,  A  Protracted  Case  of  Typhoid  Fever:  Some  Features 
of  Treatment,  Trans.  Phila.  Coimty  Med.  Soc,  1895. 

2  Osier  and  McCrae's  System,  vol.  i,  p.  213. 


78  HYDROTHERAPY 

character.  Patients  are  not  to  be  treated  in  a  routine  manner, 
and  fever  patients,  above  all,  are  not  to  be  given  antipyretics, 
either  internally  or  externally,  simply  because  the  body  tem- 
perature rises  above  a  certain  mark. 

Attention  has  been  called  of  late  by  our  best  clinicians  to 
the  fact  that  either  a  local  or  general  fever  develops  in  practically 
all  infectious  processes,  failing  to  develop  only  in  those  cases 
in  which  the  infection  is  so  overwhelming  that  the  organism  does 
not  have  an  opportunity  to  protect  itself.  If  an  animal  be  given 
a  moderate  infection  it  speedily  recovers  if  fever  is  permitted  to 
occur,  whereas,  if  fever  is  prevented,  it  dies.^  Dr.  Hare  has 
pointed  out  that  if  fever  is  prevented  by  the  use  of  antipyretic 
measures,  infections  otherwise  innocent  prove  fatal,  and  from 
this  we  learn  the  important  fact  that  in  the  vast  majority  of 
instances  the  physician  should  not  attempt  to  modify  fever,  but 
rather  to  regard  it  as  a  helpful  ally,  and  as  a  manifestation 
which  will  help  him  materially  in  guaging  the  severity  of  the  ill- 
ness and  the  ability  of  his  patient  to  combat  it,  although  when 
the  fever  becomes  a  hyperpyrexia,  exceeding  103°  or  104°  F. 
(39.5°  or  40°  C),  for  a  considerable  period  of  time,  it  may 
become  a  symptom  which  requires  attention.  This  view,  at  first 
sight,  may  seem  to  be  in  opposition  to  the  well-recognized  value 
of  the  employment  of  the  cold  bath  in  typhoid  fever,  but  in 
reality  no  such  antagonism  exists,  because  it  has  been  proved 
that  the  use  of  the  cold  bath  in  typhoid  fever  actually  increases 
the  production  of  heat  in  the  body,  and  probably  at  times 
actually  raises  the  temperature  of  the  internal  organs,  at  least 
for  a  few  moments.  In  other  words,  the  use  of  the  cold  bath  in 
typhoid  fever,  to  use  a  simile,  opens  the  draughts  and  increases 
oxidation  processes — that  is,  it  increases  the  production  of  heat, 
although  at  the  same  time  a  large  amount  of  heat  is  abstracted 
from  the  body  by  its  exposure  to  cold.  To  express  it  differently, 
the  metabolic  changes  which  are  produced  by  the  increased 
oxidation  processes  associated  with  the  cold  bath  aid  the  system 
materially  in  combating  the  infection,  not  only  the  heightened 

*  H.  A.  Hare,  Therapeutic  Gazette,  March  15,  1910. 


MEASLES  79 

temperature,  but  the  metabolic  changes,  as  just  pointed  out, 
being  protective  in  their  nature.  MacCallum  ^  goes  so  far  as  to 
express  his  conviction  not  only  that  the  febrile  process  is  an 
action  beneficial  to  the  organism,  but  believes  that  it  is  intimately 
associated  with  the  development  of  protective  substances  to 
combat  the  injurious  agencies  which  have  invaded  the  body. 

MEASLES 

In  measles  the  common  practice  is  to  use  lukewarm  baths, 
96°  to  98°  F.  (35.6°-36.7°  C),  to  bring  out  the  eruption  and, 
possibly,  cool  sponging  if  the  fever  be  high.  European  authori- 
ties, especially  Winternitz,  hold  that  the  indications  are  for 
powerful  mechanical  with  only  slight  thermic  stimulation.  Rub- 
bing down  with  a  fine  linen  cloth  wrung  out  of  quite  cold  water 
responds  to  the  indications  in  measles.  The  delayed  eruption 
frequently  appears  at  once  after  this  procedure,  and  threatening 
symptoms  vanish. 

If  the  child  be  irritable,  the  nurse  may  sponge  with  a  mixture 
of  one-fourth  alcohol  and  three-fourths  water  at  80°  F.  (26.7°  C.) 
under  the  bed-clothes,  and  thus  prepare  the  way  for  full  baths. 
There  is  no  objection  to  giving  cool  water  to  drink  during  the 
febrile  stage. 

Hot  full  baths  at  103°  F.  (39.5°  C.)  have  been  warmly  advo- 
cated by  Dr.  Friedrich  Grosse,  of  New  York,  for  very  young 
children.^  The  duration  is  only  three  minutes  for  a  child  one 
year  old,  but  may  be  lengthened  to  four  or  six  minutes  later  on. 
Some  hotter  water  is  added  during  the  bath,  so  as  to  bring 
the  temperature  up  to  106°  or  107°  F.  (41.1°  or  41.6°  C),  and 
this  proves  a  wonderful  stimulant  in  cases  of  impending  collapse. 
The  baths  are  repeated  several  times  a  day.  Children  do  not 
react  to  cold  water,  and  in  poorly  developed  and  poorly  nourished 
children  the  higher  temperatures  of  the  bath  are  much  better 
borne.    They  require  baths  considerably  higher  than  adults. 

The  late  Dr.  Hiram  Corson,  of  Pennsylvania, treated  thousands 

1  W.  G.  MacCallum  in  his  Harvey  Lectvire,  1909. 

2  Archives  of  Pediatrics,  May,  1908. 


80  HYDROTHERAPY 

of  children  with  measles,  and  claimed  that  he  never  lost  a  case. 
He  gave  a  laxative  and  sponged  the  whole  body  with  cold  water.' 
In  severe  cases  baths  may  be  given  ever}'  two  hours  night 
and  day  at  60°  to  G8°  F.  (15.6°-20°  C).  In  general,  the  hydro- 
therapy of  measles  is  similar  to  that  of  scarlet  fever.  Currie's 
method  of  cold  bathing  in  these  diseases  applies  to  the  more 
severe  types.^ 

SCARLET  FEVER 

Ordinarily  in  scarlet  fever  the  patient  should  be  sponged  over 
the  entire  body  twice  a  clay,  using  three-fourths  water  and  one- 
fourth  alcohol,  cold,  cool,  or  lukewarm,  depending  upon  the 
fever.     Petrolatum  or  cold  cream  should  then  be  used. 

In  mild  cases  a  lukewarm  or  hot  bath  is  commonly  used  to 
favor  the  action  of  the  skin;  but  in  severe  cases,  where  the  vessels 
display  a  paralytic  tendency,  the  most  energetic  thermal  stimula- 
tion is  demanded,  with  avoidance  of  much  mechanical  stimula- 
tion of  the  skin.  Brief  dips  and  douches  of  quite  cold  water 
are  often  surprisingly  effectual. 

The  most  prominent  signs  of  collapse  and  heart  weakness,  in 
this  as  in  other  affections,  are  the  high  temperature  in  the  mouth 
and  rectum,  with  clammy  extremities.  This  condition  calls  at 
once  for  the  application  of  heat  to  the  periphery  and  the  ab- 
straction of  heat  from  the  trunk.  Cold  packs  to  the  trunk  and 
heat  to  the  extremities  will  save  many  a  desperate  case. 

Even  in  desperate  cases  it  will  be  a  mistake  to  apply  water 
too  suddenly  to  the  patient,  and  thus  frighten  him  and  arouse 
antagonism.  The  requisite  degree  of  cold  may  be  obtained  by 
gradual  stages,  thus  avoiding  nervous  excitement  of  the  child  and 
retaining  the  confidence  of  the  parents.  There  is  a  prevalent 
and  time-honored  belief  that  cold  water  should  not  be  used  in 
scarlet  fever  and  measles  lest  the  rash  be  repressed  or  "go  in," 
and  it  takes  courage,  tact,  and  good  judgment  on  the  part  of  the 
attending  physician  to  adopt  and  carry  out  successfully  measures 

1  See  University  Medical  Magazine,  Philadelphia,  1891. 

2  James  Currie,  Medical  Reports  on  the  Effects  of  Water,  Cold  and  Warm, 
as  a  Remedy  in  Fever  and  Other  Diseases,  London,  1797. 


SCARLET   FEVER  81 

SO  much  opposed  to  widespread  belief.  However,  the  public  is 
gaining  confidence  in  the  use  of  cold  water,  especially  since  the 
Brand  method  of  cold-water  bathing  has  been  so  widely  practised 
with  such  evident  success.  The  more  prevalent  use  of  cold  com- 
presses and  ice  in  pneumonia  has  also  aided  in  this  change  of 
sentiment.  The  best  of  modern  specialists  in  children's  diseases 
hold  that  there  is  no  disease  of  childhood  with  high  temperature 
in  which  the  application  of  water  to  the  skin  does  harm. 

The  indications  for  the  use  of  cold  are  high  temperature, 
restlessness,  loss  of  sleep,  rapidity  of  the  heart,  and  an  evident 
lowering  of  the  vitality.  The  degree  of  temperature  cannot  be 
stated  arbitrarily;  at  least,  the  thermometer  must  not  be  too 
implicitly  relied  upon.  In  some  cases  unfavorable  symptoms 
may  coexist  with  a  temperature  of  only  103°  F.  (39.5°  C);  in 
others  at  104°  or  105°  F.  (40  or  40.5°  C).  The  physician  must 
be  the  judge,  and  it  is  probably  better  to  begin  the  use  of  cold 
at  the  lower  temperature  of  103°  F.  (39.5°  C.)  than  to  wait  for  the 
development  of  the  higher  record.  Cases  must  be  decided  on 
their  individual  needs. 

The  Cool  Pack  in  Scarlet  Fever. — This  is  a  safe  and  effective 
method  of  meeting  pyrexia  and  its  associate  bad  symptoms.  The 
use  of  this  cooling  wet  pack  in  the  graduated  method  advocated 
by  Kerley^  is  practical  because  it  avoids  unnecessary  shocks, 
is  easily  applied,  and  accomplishes  good  results.  It  is  given  as 
follows : 

Preparation  of  the  Cool  Pack. — First  the  bed  is  protected  with 
a  rubber  sheet.  A  large  bath-towel  or  some  thick,  soft  absorb- 
ent material  should  be  used  for  the  pack;  muslin,  Hnen,  or  any 
thin  material  does  not  answer  so  well.  Slits  are  cut  in  the 
towel  large  enough  for  the  arms  to  pass  through,  and  the  towel 
is  folded  around  the  body,  enveloping  only  the  trunk  and  but- 
tocks. The  pack  should  not  extend  below  the  middle  of  the 
thighs.  This  leaves  the  arms  and  the  greater  part  of  the  lower 
extremities  free.  A  hot-water  bag,  carefully  guarded,  should 
be  placed  at  the  feet  and  the  patient  covered  with  a  blanket 

1  C.  G.  Kerley,  Jour.  Amer.  Med.  Assoc,  Oct.  24,  1908. 
6 


82  HYDROTHERAPY 

of  medium  weight.  The  towel  is  moistened  with  water  at  95°  F. 
(35°  C).  This  higher  temperature  is  necessary  at  first  in  order 
not  to  frighten  the  patient,  as  sudden  cold  is  likely  to  do,  and 
also  to  avoid  shock.  In  two  or  three  minutes  the  towel,  without 
being  removed,  is  again  moistened  with  water  at  90°  F.  (32.2°  C), 
later  with  water  at  85°  F.  (29.5°  C),  and  still  later  at  80°  F. 
(26.7°  C).  When  the  temperature  of  the  water  reaches  80°  F. 
(26.7°  C.)  it  is  better  to  hold  it  at  this  point  for  half  an  hour; 
then  the  patient's  temperature  should  again  be  taken.  If  at 
the  beginning  his  temperature  was  105°  F.  (40.5°  C.)  and  now 
shows  but  slight  or  no  reduction,  the  temperature  of  the  water 
with  which  the  towel  is  moistened  should  be  reduced  to  70°  F. 
(21.1°  C.)  or,  if  necessary,  even  to  60°  F.  (15.0°  C).  The  child 
throughout  need  not  be  disturbed,  except  to  turn  him  from  side 
to  side  to  wet  the  towel  with  water  of  the  desired  tempera- 
ture, this  being  one  of  the  advantages  of  the  pack  over  a  tub- 
bath  or  sponging. 

Duration  of  Pack. — For  the  first  hour  or  two  in  a  pack  the 
temperature  of  the  patient  should  be  taken  every  half-hour. 
When  it  is  reduced  to  102°  F.  (38.9°  C),  the  pack  should  be 
removed,  for,  if  it  be  continued  longer,  too  great  a  reduction 
may  take  place.  If  it  rise  again  rapidly  to  105°  F.  (40.5°  C.) 
or  higher,  it  is  well  to  keep  the  patient  in  the  pack  continuously. 
The  degree  of  cold  necessary,  in  the  individual  case,  to  keep  the 
temperature  within  safe  limits  will  soon  be  learned.  In  a  case 
of  lobar  pneumonia,  the  patient,  a  boy  four  years  of  age,  was  kept 
in  a  pack  for  seventy-two  hours.  A  continuous  pack  of  70°  F. 
(21.1°  C.)  was  required  to  keep  the  temperature  at  104°  F. 
(40°  C.)  or  slightly  lower. 

The  towel  or  other  material  employed  should  not  be  used  for 
more  than  six  hours,  when  it  should  be  changed  for  a  fresh  one. 
Another  reason  for  frequently  taking  the  temperature  is  that  early 
in  the  attack  we  do  not  know  how  it  will  be  affected  by  the  con- 
tinued cool  applications.  In  some  children  it  is  very  readily 
influenced,  and  in  such  a  case  collapse  might  follow  a  very  sudden 
reduction  of  the  temperature.     In  cases  readily  controlled,  the 


SCARLET   FEVER  83 

pack  may  be  necessary  for  only  one-half  hour  or  an  hour,  at 
intervals  of  three  or  four  hours.  An  ice-bag  may,  with  ad- 
vantage, be  kept  at  the  head  when  the  child  is  in  the  pack. 

In  ordinary  cases  a  daily  warm  bath  at  90°  to  98°  F.  (32.2°- 
36.7°  C.)  may  be  given,  but  little  friction  should  be  used  in 
drying  the  body.  Such  a  bath  tends  to  reduce  the  body  heat 
and  to  quiet  restlessness.  If  the  temperature  of  the  bath  be 
above  98°  F.  (36.7°  C.)  or  below  90°  F.  (32.2°  C),  there  is  a 
liability  to  depression  or  collapse.  Such  a  bath  obviously 
cannot  be  continued  very  long,  and,  besides,  is  likely  to  frighten 
the  child  and  render  any  bathing  difficult.  Baths  between 
90°  and  95°  F.  (32.2°  and  35°  C.)  are  most  agreeable  and  may  be 
repeated  every  three  or  four  hours,  if  need  be,  without  any 
unpleasant  effects.  Water  at  92°  to  94°  F.  (33.3°-34.5°  C.)  has 
a  sedative  effect,  and  affords  a  protection  to  the  central  nervous 
system  from  reflex  irritation. 

Hence,  bathing  should  be  instituted  early,  so  as  to  forestall 
convulsions  and  delirium.  The  presence  of  somnolence,  nervous 
depression,  or  unconsciousness  is  not  to  be  construed  as  counter- 
indicating  this  manner  of  bathing. 

Dr.  D.  S.  Hanson,  of  Cleveland,  has  strongly  advocated  bath- 
ing in  scarlet  fever^  and  cites  some  remarkably  good  results : 

"If  a  bath-tub  be  at  hand,  the  patient  may  be  lowered  into 
it  lying  on  a  sheet,  and  a  rubber  air-pillow  placed  under  the  head 
is  a  convenience,  but  neither  are  a  necessity,  and  my  patients 
have  invariably  been  bathed  in  an  ordinary  wash-tub,  such  a 
luxury  as  a  bath-tub  not  being  at  hand. 

"I  wish  especially  to  emphasize  the  early  use  of  the  bath, 
for  in  these  severe  nervous  cases  changes  go  on  very  rapidly 
in  the  central  nervous  system.  For  example :  I  recently  treated 
a  case  of  cerebrospinal  meningitis  in  which  fibrin  and  pus  were 
present  in  the  cerebrospinal  fluid  within  twenty-one  hours  from 
the  beginning  of  the  attack,  and  changes  in  the  foudroyant  tj^pe 
of  scarlatina  are  often  equally  severe  and  rapid. 

"  In  the  toxic  type,  with  high  fever,  intense  rash,  great  rest- 

1  Jour.  Amer.  Med.  Assoc,  Oct.  17,  1908. 


84  HYDROTHERAPY 

lessness,  often  with  double  rash,  rapid  respiration  and  pulse, 
often  beginning  with  convulsions  and  great  mental  depression, 
later  often  with  cold  extremities  and  cyanosis,  even  cases  occur 
in  which  toxemia  is  intense,  with  little  or  no  elevation  of  tem- 
perature, but  with  marked  depression  of  the  nervous  system, 
manif(>sted  by  delirium,  somnolence,  apathy,  or  unconsciousness. 

"It  is  in  the  early  stages  of  these  severe  toxic  cases  where 
the  happy  effects  of  this  line  of  treatment  can  most  frequently 
be  seen,  although  in  cases  with  high  temperature,  where  these 
severe  nervous  symptoms  are  not  present,  the  benefits  to  be  ob- 
tained are  nearly  as  striking  and  will  do  more  good  than  any  other 
single  measure. 

"The  method  I  have  used  with  the  most  satisfaction  is  with 
the  water  at  a  temperature  of  90°  F.  (32.2°  C),  each  bath  lasting 
from  five  to  ten  minutes,  with  very  gentle  friction  to  the  body 
surface  while  in  the  bath,  the  bath  to  be  repeated  sufficiently 
often  to  control  temperature  and  symptoms.  Sometimes  it  has 
been  necessary  to  do  this  as  often  as  every  two  or  four  hours  for 
three  or  four  days." 

"Case  1. — E.  W.,  aged  five  years.  The  case  was  ushered  in 
by  a  convulsion,  vomiting,  and  diarrhea;  the  convulsion  was  im- 
mediately followed  by  somnolence  and  muttering  delirium, 
temperature  very  high,  and  rash  beginning  to  show  on  neck 
and  chest.  The  bath  was  inmiediatoly  given,  and  the  child 
conversed  intelligently  with  her  father  before  being  removed 
from  the  tub.  The  tubbing  was  continued  as  indicated  by  rest- 
lessness and  elevation  of  temperature  for  three  or  four  days, 
resulting  in  a  good  recovery  and  no  sequelie." 

"Case  2. — E.  H.,  aged  three  and  one-half  years,  seen  the 
second  day  of  an  attack  that  was  of  apparently  no  great  severity 
Crectal  temperature  not  above  102°  F.  (38.9°  C.)  at  any  time)  and 
rash  well  out,  with  a  phanrngitis  of  moderate  severity,  kidneys 
normal.  Her  father  telephoned  that  the  child  seemed  disturbed 
mentally,  that  she  did  not  seem  to  understand  what  was  said  to 
her,  antl  was  delirious.  On  mj'-  arriA'al,  a  half-hour  later,  she 
was  apathetic,  muscles  of  face  twitching,  she  could  not  be 


SCARLET   FEVER  85 

aroused  from  stupor,  and  was  constantly  muttering.  The  bath 
had  as  happy  an  effect  as  in  the  last  case,  the  nervous  symptoms 
disappearing  like  magic.  This  case  illustrates  the  benefit  to  be 
derived  in  nervous  depression  when  not  dependent  on  high  tem- 
perature, and  must  have  produced  such  marked  results  in  some 
way  independent  of  its  effects  on  the  temperature." 

"  Case  3. — This  was  in  a  child,  aged  six,  rapidly  passing  into 
a  very  dangerous  state.  Bathing  was  recommended  as  the  only 
treatment.  The  recommendation  was  accepted  and  the  treat- 
ment immediately  begim.  A  bath  at  the  temperature  of  90°  F. 
(32.2°  C.)  was  used,  with  plenty  of  cold  water  poured  on  the  head 
while  in  the  bath.  The  duration  of  the  bath  was  fifteen  minutes, 
and  was  continued  every  two  hours  day  and  night.  There  was 
no  change  the  first  day,  except  that  the  temperature  was  reduced 
to  and  held  at  103°  F.  (39.5  C).  After  twenty-four  hours' 
bathing  the  condition  of  stupor  was  much  improved.  She  was 
now  conscious  of  her  surroundings  and  resisted  when  put  into  the 
bath.     She  also  drank  water  and  a  little  milk. 

"A  little  medicine  was  given  from  now  on,  but  the  baths  were 
yet  continued  day  and  night.  By  the  fourth  day  the  rash  began 
to  appear  and  was  very  profuse  two  or  three  days  later.  The 
throat  symptoms  were  also  very  severe.  The  stupor  and  rest- 
lessness soon  disappeared  and  the  progress  of  the  case  was  in 
every  way  satisfactory.  There  were  no  sequelae  of  any  kind 
except  five  or  six  abscesses  which  developed  during  the  period  of 
convalescence." 

K.  Oppenheimer  ^  discusses  the  treatment  of  scarlet  fever 
with  particular  reference  to  baths  and  diet.  He  disagrees  with 
the  majority  of  the  German  authors,  agreeing  rather  with  French 
and  American  observers  in  regard  to  baths  and  cold  sponging; 
he  does  not  employ  them  unless  the  nervous  system  is  affected. 
He  considers  their  influence  dangerous  for  the  heart,  and,  more 
particularly  through  the  possibility  of  taking  cold,  for  the  kidneys. 
He  thinks  that  cold  water,  even  if  applied  in  the  form  of  packs, 
is  liable  to  chill  the  kidneys  and  lead  to  nephritis.     In  the  first 

1  Miinch.  med.  Woch.,  1908,  iv,  1691. 


86  HYDROTHERAPY 

stage  of  the  illness  his  treatment  is  purely  expectant;  rest  with 
plenty  of  water  is  probably  all  the  child  requires  during  this  time ; 
if  the  child  does  not  wish  to  eat  or  drink,  he  does  not  force  food, 
but  considers  the  rest  more  important.  As  soon  as  the  child 
evinces  some  appetite,  milk  is  given,  also  diluted  tea;  later  in  the 
disease  any  food  usually  given  a  child  is  allowed,  with  the  excep- 
tion of  meat,  eggs,  and  their  products.  He  emphasizes  that  none 
of  the  foods  must  be  salted  too  much.  He  keeps  his  patients 
in  bed  for  from  five  to  six  weeks;  in  the  sixth  week  he  permits 
warm  bathing,  using  a  1  per  cent,  corrosive  sublimate  solution 
for  the  body.  He  has  never  seen  a  single  kidney  complication 
during  the  last  eighteen  years,  although  he  has  treated  in  that 
time  more  than  150  cases. 

If  adenitis  threatens,  cold  compresses  nmst  be  j)romptly  ap- 
plied to  the  throat  and  neck,  and  repeated  hourly. 

Early  bathing  favors  early  desquamation,  and  in  older  subjects 
this  is  a  great  advantage  in  shortening  the  period  of  communica- 
bility.  Unusual  efforts  to  detach  the  skin  from  the  body  are  not 
advised.  A  good  method  is  to  soak  the  soles  of  the  feet  once 
daily  in  a  solution  of  sodium  carbonate  (washing-soda)  for  ten 
minutes  and  then  in  hot  soapsuds  for  the  same  length  of  time, 
after  which  they  are  to  be  rubbed  with  a  coarse  towel.  The 
strength  of  the  soda  solution  should  be  about  1  ounce  of  soda  to 
2  gallons  of  water.  Bathing  in  this  manner  favors  desquama- 
tion and  shortens  the  time  of  quarantine.* 

Oil  Inunctions. — As  a  substitute  for  hydrotherapy  in  scarlet 
fever  inunctions  of  oil  are  useful.  They  are  almost  always 
grateful  to  the  i)atient. 

Diphtheria. — In  this  disease  cold  gives  relief.  Powdered 
ice,  enclosed  in  thin  rubber  bags,  may  also  be  bound  over  the 
throat  and  under  the  ears. 

Similar  measuses  may  be  used  in  parotitis,  although  hot 
applications  will  generally  be  found  more  grateful. 

1  See  Pfaundler  and  Schlossman,  English  translation;  also  article  on  Hot 
Baths  in  Scarlet  Fever,  by  H.  W.  Rorer,  Colorado  Medicine,  July,  1908. 


CEREBROSPINAL   MENINGITIS  87 

CHOREA 

After  washing  the  child's  face  in  cool  water,  he  is  placed 
gently  in  a  tub  of  water  of  90°  to  98°  F.  (32.2°-36.7°  C). 
This  temperature  will  prove  agreeable  at  the  start.  The  water 
can  be  cooled  not  more  than  10  or  15  degrees  during  the  bath. 
Children  can  usually  be  amused  for  an  hour  with  playthings  or 
floating  toys,  so  that  the  time  will  pass  rapidly.  The  bath  may 
last  an  horn-  and  be  repeated  once  in  the  day.  Toward  the  end 
of  the  bath  there  should  be  superficial  massage  of  the  arms,  legs, 
and  trunk,  and  after  removal  from  the  bath  the  child  will  prob- 
ably take  a  nap.  Success  by  this  method  without  medication 
has  been  reported.  Coincident  heart  disease  offers  no  counter- 
indication. 

Wet  packs  of  from  one  to  one  and  a  half  hours'  duration  are 
useful  in  chorea  when  baths  for  any  reason  are  not  convenient, 
but  wet  packs  should  not  be  given  when  there  is  great  weakness, 
especially  of  the  heart.  They  should  be  used  in  connection  with 
a  cold  precordial  coil  after  the  manner  of  Buxbaum.  The  coil 
should  not  be  appHed  directly  to  the  skin,  nor  allowed  to  remain 
in  place  more  than  thirty  or  forty  minutes  at  a  time,  and  in  some 
cases  less,  as  the  ice-water  in  the  coil  may  chill  the  surface,  render- 
ing it  cyanotic.  After  fifteen  minutes'  interval  the  coil  may  be 
reapplied.     (See  p.  386.) 

In  a  case  observed  by  Kraus  an  intense  and  slightly  febrile 
chorea  was  developed  while  the  patient  was  under  hydrothera- 
peutic  treatment  for  the  relics  of  subacute  articular  rheumatism. 

CEREBROSPINAL  MENINGITIS 

Warm  baths  are  indicated  in  this  formidable  disease.  The 
water  temperature  should  be  104°  F.  (40°  C),  and  the  bath 
may  be  continued  for  thirty  to  forty-five  minutes  and  given  three 
or  four  times  daily.  Although  the  writer  has  not  had  any  ex- 
perience in  treating  this  disease,  reports  of  others  show  that  there 
is  a  marked  amelioration  of  the  symptoms  and  a  decrease  in 
mortality  in  cases  treated  by  hydrotherapeutic  measures.^ 
1  Albany  Medical  Annals,  March,  1905.     Article  by  C.  G.  Stockton. 


88  ■,,  HYDROTHERAPY 

To  obtain  the  best  results  the  treatment  should  be  given  early. 
Aufrechtjin  1894,  initiated  this  form  of  treatment,  and  Rogansky,^ 
in  1904,  published  the  records  of  51  patients  treated  with  baths 
at  104^  F.  (40°  C.)  for  fifteen  or  twenty  minutes,  once  or  twice 
a  day.  Ice-bags  were  always  placed  on  the  head  of  the  patient 
during  the  bath.  The  baths  had'  a  marked  effect  in  relieving 
delirium  as  early  as  the  first  or  second  bath,  and  always  relieved 
pain.  Of  the  51  patients,  34  were  cured  and  17  died — a  mortalit}'- 
of  33  per  cent.  In  the  men's  ward  of  the  hospital  during  the 
same  epidemic  50  cases  were  treated  by  other  means,  and  the 
mortality  was  80  per  cent. 

Dr.  Alfred  Wolisch  reports  7  cases,  of  which  5  completely 
recovered.  Of  the  deaths,  1  was  a  foudroyant  case,  which  died 
within  forty-eight  hours;  the  other  4  died  in  the  late  stage  of  the 
disease,  the  baths  being  employed  only  during  the  first  two  weeks. 

No  statement  can  be  definitely  made  as  to  the  precise  action 
of  the  baths,  although  it  is  probable  that  the  resulting  hyperemia 
of  the  skin  lessens  the  amount  of  blood  contained  in  the  brain 
and  spinal  cord.  It  is  also  likely  that  in  the  markedly  increased 
perspiration  the  toxin  which  has  accumulated  in  the  blood  may 
be  eliminated.  These  baths  in  the  reported  cases  seem  to  lower 
the  temperature,  to  have  a  toning  and  regulating  influence  upon 
the  heart,  and  to  relieve  pain  and  restlessness.  They  may  be 
used  in  connection  with  Flexner's  antimeningitis  serum  with  good 
effect. 

The  method  is  as  follows :  The  patient  is  placed  in  the  bath 
at  the  temperature  of  90.5°  to  92.75°  F.  (32.5°-33.8°  C),  and 
hot  water  gradually  added  until  104°  F.  (40°  C.)  is  reached. 
While  in  the  bath  an  ice-bag  or  a  Lciter  cold-water  coil  is  placed 
on  the  head.  The  placing  in  and  removal  from  the  bath  are 
done  with  great  care  and  rapidity ;  this  means  close  proximity  of 
bath  and  bed,  and  both  should  be  at  the  same  level.  If  there  be 
great  tenderness  of  the  back,  the  sheet  may  be  used  to  move 
the  patient.  The  bath  must  be  previously  cushioned  and 
thorough  after-drying  omitted.    The  patient  is  placed  upon  a 

1  Meditsinskoye  Obozreniye,  October,  1904. 


TETANUS  89 

dry  sheet,  laid  upon  a  woolen  quilt,  with  which  he  is  covered. 
A  light  cover  is  then  placed  over  him,  and  he  is  allowed  to  remain 
in  this  position  for  one  hour. 

The  time  of  the  bath  is  immaterial — early  morning  or  late 
evening.  Nourishing  food,  even  meat,  should  be  given.  Even 
diarrhea,  should  it  occur,  •  does  not  contraindicate  the  bath. 
Wine,  brandy  (in  milk),  also  beer  are  given,  for  the  author 
regards  alcohol  as  a  tonic  and  hypnotic  of  the  first  rank  in  this 
disease.^ 

The  hot  bath  may  be  given  in  the  convulsions  of  children,  but 
priority  should  be  given  to  such  medicinal  measures  as  the  chloral 
enema,  chloroform,  or  nitrite  of  amyl  inhalations.  For  the 
technic  see  p.  88. 

TETANUS 

In  tetanus  the  hot  pack  (see  p.  341)  is  a  valuable  accessory 
to  other  forms  of  treatment. 

Warm  baths,  also,  are  indicated. 

Cold  baths  were  strongly  advocated  by  James  Currie  as 
early  as  1781,  and  cold  affusions  by  Wright,  of  Jamaica,  who  was 
accustomed  to  treat  tetanus  in  the  West  Indies.  Currie  treated 
a  soldier  in  February  with  salt-water  baths  at  36°  F.  (2.2°  C), 
into  which  the  patient  was  plunged  headlong  and  afterward  en- 
veloped in  warm  blankets  and  rubbed  briskly.  The  result 
was  most  satisfactory  after  all  other  measures  had  failed. 

Currie  relates  other  cases  successfully  treated  in  this  way, 
and  quotes  Hippocrates  and  Avicenna  as  having  used  cold 
baths  in  the  treatment  of  tetanus.^ 

The  modern  treatment  of  tetanus  with  antitetanic  serum 
and  warm  baths  and  packs  is  more  successful  than  the  ancient 
method  of  cold  bathing. 

Yellow  Fever. — In  the  early  stage  the  patient  should  be 
given  a  hot  mustard  bath  or  foot-bath.  Blankets  should  be 
used  until  free  perspiration  occurs. 

iTherapeutische  Monatshefte,  1896,  Heft  5,  S.  254. 

"  Hippocrates  Aphor.,  21,  liber  5;  Avicenna  Liber,  3,  cap.  7. 


90  HYDROTHERAPY 

Cholera. — In  case  of  collapse  the  patient  should  be  placed 
m  a  hot  bath  (104°  to  105°  F.— 40°-40.6°  C.)  for  ten  minutes, 
and  this  may  be  repeated  every  two  or  three  hours.  Hot  wet 
packs  may  be  used  in  place  of  baths. 

INSOLATION;    SUNSTROKE;    HEAT    STROKE; 
THERMIC   FEVER 

Hydrotherapy  is  the  sheet-anchor  of  treatment  in  sunstroke 
or  thermic  fever.  The  rapid  onset  and  the  very  high  degree  of 
fever  demand  prompt  action,  death  occurring  sometimes  within 
an  hour. 

The  patient  should  be  stripped  of  clothing  and  placbd  on  a 
stretcher  covered  with  a  mbber  sheet.  The  head  should  be 
slightly  raised,  an  ice-cap  applied,  and  iced  cloths,  frequently 
changed,  placed  about  the  forehead  and  neck. 

For  the  excessive  temperature,  sometimes  reaching  106°  tp 
108°  to  110°  F.  (41.1°-42.2°-43.3°  C),  the  patient  should  be 
sprayed  with  ice-water,  using  a  watering-can  or  syringe  with  a 
fine  nozzle.  A  sprinkler  provided  with  a  temperature-indicating 
handle  will  prove  very  useful  (see  p.  245).  A  cold  sheet  bath  is 
also  excellent.  Vigorous  friction  should  be  used  all  over  the 
body  and  the  limbs  during  the  entire  time  in  the  sheet  or  under 
the  spray.  Dipperfuls  of  cold  water  may  be  dashed  on  the 
patient. 

The  duration  of  the  bath  is,  to  some  extent,  regulated  by  the 
fall  in  temperature.  ^Yhen  this  falls  from  106°  or  107°  F. 
(41.1°  or  41.7°  C.)  to  102°  F.  (38.9°  C),  or  from  108°  or  110°  F. 
(42.2°  or  43.3°  C.)  to  103°  F.  (39.5°  C),  the  patient  may  be 
placed  in  bed  with  an  ice-cap  applied  and  covered  with  a  thin 
sheet.  Friction  of  the  skin  to  bring  the  deeper  blood  to  the 
surface;  the  use  of  ice-water  enemata;  and,  in  cases  where  the 
pulse  is  tense  and  full  and  the  mental  state  bad,  the  use  of  free 
venesection  can  be  carried  out.  Later  the  bath  should  be  re- 
peated. A  little  cold  water  should  be  given  by  the  mouth  when 
possible. 

An   ice-water  enema  is  given  as  follows:  By  means  of  a 


insolation;  sunstroke;  heat  stroke;  thermic  fever    91 

rectal  tube  4  or  5  pints  of  water,  gradually  lowered  from  90°  to 
45°  F.  (32.2°-7.2°C.),  are  introduced  high  up  into  the  rectum 
and  allowed  to  be  retained  for  about  ten  minutes.  Using  the 
warm  water  first  favors  retention,  so  that  a  second  injection  at 
40°  to  45°  F.  (4.5°-7.2  °  C.)  wiU  not  be  expeUed. 

One  can  give  an  ice-water  enema  with  a  minimum  of  ice. 
In  India  this  is  a  favorite  army  method  and  very  successful 
since  its  introduction  by  Captain  W.  A.  Heppolette  and  Captain 
Foulds.  The  latter  relates  his  experience  with  9  cases  of  sun- 
stroke occurring  when  the  thermometer  ranged  from  105°  to 
115°  F.  (40°-46°  C.)  in  the  shade.  These  men  were  taken  into 
the  hospital  unconscious  and  with  deep  stertorous  breathing, 
dry  burning  skin,  and  a  temperature  of  107°  to  110°  F.  (41.4°- 
43.2°  C).  They  were  stripped  and  put  to  bed  in  the  shade. 
One  attendant  poured  water  over  them  as  cold  as  could  be  ob- 
tained, and  two  others  rubbed  the  body  with  ice.  An  enema  of 
about  1  quart  of  ice-water  was  given  every  ten  minutes  until  the 
axillary  temperature  fell  to  102°  F.  (39°  C).  All  the  patients 
recovered.^  Six  other  men  were  taken  into  the  hospital,  drowsy 
and  complaining  of  pains  in  the  head  and  dizziness,  and  with 
temperatures  varying  from  103°  to  105°  F.  (39.4°-40.5°  C.)— 
i.  e.,  with  all  the  prodromata  of  sunstroke.  They  were  treated 
with  ice-water  enemata  and  left  the  hospital  quite  well  on  the 
following  morning. 

The  time  element  is  very  important  and  there  should  be  no 
delay.  It  is  better  to  apply  the  best  measures  at  hand  than  to 
wait  to  transport  the  patient  any  distance.  One  can  certainly 
loosen  the  clothing  and  dash  water  as  cold  as  can  be  had  against 
the  temples  and  the  throat.^  During  hot  weather  ambulances 
should  be  provided  with  ice  and  water,  so  that  affusions  and  ice 
rubbing  can  be  immediately  practised.  Cases  of  sunstroke 
have  been  lost  for  lack  of  any  such  provision. 

^  Indian  Medical  Gazette,  December,  1906. 

2  See  articles  on  Treatment  of  Sunstroke,  by  Drs.  Dryce,  G.  W.  Longen- 
ecker,  R.  A.  Bachmann,  U.  S.  N.,  T.  H.  Ross,  G.  B.  Foster,  New  York  Medical 
Jour.,  July  4,  1908;  see  also  p.  245  for  technic,  and  p.  436  of  Appendix. 


92  HYDROTHERAPY 

Nitroglycerin  hypodermically,  by  dilating  the  peripheral 
vessels,  aids  hydrotherapy  in  all  such  cases.  More  blood  is 
thereby  exposed  to  cold  and  a  reaction  is  favored.  After  spray- 
ing it  is  often  a  good  practice  to  wrap  the  patient  in  a  blanket 
and  put  a  hot-water  bottle  to  the  feet. 

A  great  deal  has  been  written  about  the  use  of  ice-cold  full 
baths  and  some  even  advise  packing  the  body  in  ice.  Others 
use  ice  rubbing.  The  latter  is  somewhat  more  rational,  but  ice 
packing  should  be  condemned.  It  does  not  permit  of  the  most 
important  element  in  the  treatment — the  vigorous  rubbing. 
The  patient  will  not  respond  to  a  too  general  application  of  cold : 
the  nerve-centers  are  too  much  impressed  in  severe  ceases  to 
react,  and,  in  the  absence  of  friction,  the  natural  recuperative 
powers  are  held  in  abeyance. 

Baruch's  advice  is  undoubtedly  sound  and  he  has  made 
for  years  a  strong  plea  for  the  spray  bath  and  afTusions  with  con- 
stant rubbing,  recognizing  the  fact  that  nerve  depreciation  is  the 
chief  lethal  factor;  that  the  nerve-centers  are  so  overwhelmed 
by  the  high  atmospheric  temperature  acting  on  predisposed 
individuals  that  the  patient  is  incapable  of  response  to  the 
simultaneous  impact  of  very  cold  water  against  the  entire 
body. 

Moderation  in  the  use  of  cold  will  be  the  keynote  of  success 
in  these  cases.  It  is  probably  the  failures  resulting  from  the 
excessive  use  of  cold  in  these  cases  that  has  led  so  many  hospitals 
to  establish  tents  outside  of  the  permanent  buildings.  In  many 
cases  of  sunstroke  treated  in  these  tents  very  little  is  done  except 
to  cover  the  patient  with  a  sheet,  apply  an  ice-cap  to  the  head, 
and  sponge  with  cool  water. 

In  1896  there  was  great  mortality  in  New  York  from  heat. 
Dr.  Baruch  gives  the  statistics  of  520  cases  of  sunstroke  which 
were  treated  in  the  New  York  hospitals.  Of  those  who  were 
treated  with  ice-baths  ranging  in  temperature  from  50°  to  75°  F. 
(10°-24°  C),  one-third  were  reported  to  have  died;  while  in 
197  cases  treated  with  affusions  of  cold  water,  discontinued 
when  the  temperature  reached  103°  F.  (39.5°  C),  the  mortality 


TUBERCULOSIS  93 

was  only  6  per  cent.^  The  good  results  of  cold-water  sponges, 
affusions,  or  baths  are  probably  attributable  more  to  a  reflex 
action  on  the  nerve-centers  than  to  the  incidental  withdrawal 
of  heat.  Hence  we  should  not  fix  our  attention  on  heat  reduction , 
especially  from  the  higher  stages  of  108°  or  109°  F.  (42.2°  or  42.7° 
C.)  to  near  the  normal  mark  in  a  single  bath,  but  rather  on  the 
moderate  use  of  cold,  a  better  action  of  the  heart  and  respiration, 
and  on  the  state  of  the  nervous  system. 

TUBERCULOSIS 

Prophylaxis. — Hydrotherapy  ma}^  serve  a  useful  purpose 
in  the  prevention  of  tuberculosis.  No  uniform  method  is  ap- 
plicable, but  the  age  and  general  constitution  will  afford  a  guide 
in  all  measures  for  the  invigoration  of  the  external  circulation. 
A  child  of  two  or  three  years  may  be  gi'adually  accustomed  to  the 
use  of  cool  water  after  the  warm  bath.  This  cool  wash  may  be  ap- 
plied while  the  child  stands  in  the  tub  with  the  warm  water 
covering  the  feet,  or  while  lying  on  the  nurse's  lap  or  on  a  mat- 
tress, or  a  wet  sponge  may  be  squeezed  over  the  body.  These 
procedures  should  be  followed  by  friction.  A  brisk  rubbing 
for  one  or  two  minutes  with  a  wet  towel  and  afterward  with  a  dry 
towel  until  the  surface  is  dry  and  warm  is  sufficient.  Older 
children  may  plunge  into  cool  water  for  from  half  a  minute  to 
several  minutes,  according  to  the  season,  the  bath,  whether 
warm  or  cool,  being  accompanied  by  thorough  friction. 

Cool  water  bathing  must  be  approached  cautiously  and  with 
tact,  as  most  children  dread  it  and  any  sudden  or  unlooked-for 
shock  will  frighten  the  child.  No  amount  of  persuasion  will  in- 
duce him  to  take  a  second  bath,  not  to  speak  of  the  unfavorable 
effect  on  a  sensitive  nervous  system.  The  child  that  needs  the 
treatment  most  will  probably  rebel  the  loudest.  Cold  water  and 
friction  presuppose  a  healthy  heart  and  some  strength.  It 
is,  therefore,  necessary  to  cultivate  a  reaction  by  imperceptible 
gradations  of  temperature  taken  by  the  aid  of  a  bath  ther- 
mometer with  favorable  atmospheric  conditions.  Dr.  Abraham 
1  Medical  News,  July  24,  1897,  Sunstroke  in  New  York  in  1896. 


94  HYDROTHERAPY 

Jacobi,  who  strongly  urges  this  plan  of  fortifying  the  system  in 
the  young,  also  points  out  that  the  healthy  child  undergoing 
this  plan  of  treatment  should  be  given  a  respite  when  taken  sick 
or  when  convalescent  from  any  acute  disease  oy  whenever  he 
lacks  the  necessary  vigor.  A  child  under  size  and  under  weight 
and  all  children  under  two  years  of  age  should  be  spared  a 
temperature  much  below  the  body  heat.  Children  also  should 
not  be  allowed  to  go  about  with  knees  anii  legs  entirely  exposed 
to  the  cold  of  our  northern  winters. 

AVhenever  the  feet  after  a  bath  or  washing  do  not  warm  as 
quickly  as  the  rest  of  the  body,  they  should  be  rubbed  with 
warm  water  or  with  a  mixture  of  alcohol  and  warm  water  until 
there  is  evidence  that  the  constitution  is  improved  and  fortified. 

Sea  bathing  and  sunning  on  the  sand  are  excellent  prophylactic 
measures  when  gradually  employed  and  not  carried  to  extremes. 
The  exposure  of  the  limbs  and  the  partial  exposure  of  the  body 
through  thin  bathing  suits  to  the  action  of  sun  and  air,  develop- 
ing tan  and  increasing  the  tone  and  natural  resistance  of  the  skin, 
constitute  the  best  safeguard  known  against  tuberculous  dis- 
ease, whether  in  the  bones,  the  glands,  or  the  lungs.  Sea  bathing 
may  thus  be  employed  as  a  preventive  measure.  In  a  suitable 
marine  climate  we  may  have  a  prevention  sanatorium  or  a 
'preventorium,  as  it  has  been  called,  in  which  hot  and  cold  sea- 
water  baths  are  afforded.  Surf  bathing  would  probably  be 
dangerous  for  cases  of  pulmonary  tuberculosis,  but  tub-baths 
with  sea-water  rubbing  would  doubtless  be  attended  with 
benefit.  Rait  rubs,  in  which  cloths  or  the  bare  hand,  after  being 
wet  in  warm  water,  are  dipped  in  finely  ground  salt  and  then 
rubbed  over  the  body,  are  also  appropriate. 

Cornet's  method  of  hydrotherapy  in  tuberculous  cases  in- 
volves the  use  of  a  5  per  cent,  solution  of  salt  (twice  the  strength 
of  sea- water)  at  90°  F.  (32.2°  C).  A  sensitive  patient,  in  the 
winter,  begins  with  ordinar}'  rubbing  by  an  attendant  morning 
and  evening.  No  water  is  used  at  first.  The  patient  is  put  into  a 
large  coarse  sheet  on  a  firm  bed  and  rubbed  with  long  quick 
strokes  from  head  to  foot,  so  that  a  strong  glow  may  be  brought 


TUBERCULOSIS  95 

to  the  skin.  In  a  week  or  so  this  is  modified  by  rubbing  the 
trunk  and  members  with  a  wash-cloth  wrung  out  of  water,  which 
in  successive  appHcation  is  lowered  from  92°  to  66°  F.  (33.3°- 
18.9°  C.)  until  there  is  a  ruddy  reaction.  The  patient  is  then 
covered  and  permitted  to  rest  for  half  an  hour.  This  treatment 
may  be  given  daily  and  preferably  before  breakfast  on  an  empty 
stomach;  but  weaker  patients  may  have  a  glass  of  warm  milk,  or 
coffee  or  tea  half  an  hour  before ;  or  the  patient  may  take  a  short 
walk  or  have  a  dry  rub  previously,  so  as  to  favor  a  good  reaction. 

If  the  preliminary  treatment  has  been  found  satisfactory, 
the  following  program  may  then  be  adopted  regularly:  The 
patient,  entirely  nude,  is  wrapped  in  a  linen  sheet  wrung  out  in 
5  per  cent,  brine  at  90°  F.  (32.2°  C),  so  appUed  that  it  comes 
in  contact  with  the  entire  body.  As  the  course  of  treatment 
progresses  the  sheet  may  be  applied  dripping  from  the  brine. 
The  patient  is  then  rubbed  by  a  trained  rubber,  with  long  power- 
ful strokes,  until  there  is  an  agreeable  feehng  of  warmth  over  the 
entire  body.  A  cloth  wet  in  cold  water  may  be  laid  on  the  head 
to  prevent  headache.  The  rubbing  lasts  but  one  or  two  minutes, 
after  which  the  patient  is  laid  on  a  dry  sheet  and  again  rubbed. 
He  dresses  without  delay  and  goes  out  into  the  open  air  for  at 
least  half  an  hour.  After  this  walk  he  takes  breakfast.  Weaker 
patients  get  into  bed  for  at  least  half  an  hour.  The  temperature 
of  the  brine  is  lowered  1°  F.  (.54°  C.)  with  each  appHcation,  until 
70°,  65°,  or  even  60°  F.  (21.1°,  18.3°,  or  15.6°  C.)  are  reached. 

The  full  rub  should  be  done  quickly,  expertly,  and  energetic- 
ally, and  preferably  by  a  trained  attendant.  Experience  will 
show  how  headache,  discomfort,  and  chilliness  may  be  avoided. 

Douches  may  be  used,  but  Cornet  limits  them  to  those  who 
are  fairly  strong  and  then  only  in  the  physician's  presence.  The 
temperature  should  be  from  90°  to  95°  F.  (32.2°-35°  C.)  or 
warmer.  The  patient  must  rub  himself  during  the  douche. 
After  he  is  dried,  he  dresses  himself  and  walks  in  the  open  air. 
Irritable  cases  and  those  with  much  sputum  are  not  suitable  for 
the  douche,  as  forced  breathing  and  aspiration  of  sputum  may 
result.    These  rubs  harden  the  body  and  render  it  less  susceptible 


96  HYDROTHERAPY 

to  changes  of  toiiiperaturc.  With  the  douches  they  are  a  neuro- 
vascular stimulant,  improving  the  "peripheral  heart,"  enhancing 
the  appetite,  nutrition,  and  general  mental  condition. 

Baruch  permits  the  initial  use  of  colder  water  and  reduces 
its  temperature  more  quickly.  The  first  step  is  a  thorough 
cleansing  with  soap  and  warm  water.  On  the  second  day  the 
patient  is  wrapped  snugly  in  a  thin  blanket  and  allowed  to  lie 
half  an  hour  or  longer  unless  he  perspires.  If  the  rectal  tem- 
perature be  above  100°  F.  (37.7°  C),  the  treatment  is  omitted, 
and  in  afebrile  cases  additional  blankets  may  be  used,  so  as  to 
dilate  the  cutaneous  arterioles  preparatory  to  being  treated  with 
water.  The  face  is  bathed  with  water  at  50°  F.  (10°  C).  The 
blanket  is  then  opened  over  the  chest  and  abdomen  and  these 
parts  rapidly  and  well  rubbed  with  water  at  75°  F.  (23.8°  C). 
After  drying,  the  patient  is  turned  on  his  abdomen  and  the  back 
is-  similarly  treated.  The  limbs  are  not  treated.  The  patient 
is  dried  gently,  dressed,  and,  if  afebrile,  he  is  sent  into  the  open 
air  for  a  short  walk.  Febrile  cases  are  returned  to  bed.  The 
treatment  is  repeated  daily  and  the  water  lowered  2°  F.  (1.08°  C.) 
at  each  ablution  until  60°  F.  (15.6°  C.)  is  reached.  When  this 
stage  is  reached  the  ablution  is  performed  as  follows,  just  as  the 
patient  emerges  warm  from  the  bed : 

Standing  in  a  foot-tub  containing  sufficient  water  at  100°  F. 
(37.7°  C.)  to  cover  the  feet  to  the  malleoli,  the  patient  receives  a 
rapid  friction  bath  with  water  at  90°  F.  (32.2°  C),  omitting  the 
upper  extremities.  He  is  then  dried  and  sent  into  the  open  air 
if  his  rectal  temperature  be  below  100°  F.  (37.7°  C).  The  water 
temperature  is  reduced  daily  2°  to  5°  F.  (1.08°-2.7°  C)  until 
60°  F.  (15.6°  C.)  is  reached,  when  the  ablution  is  replaced  by 
affusion.  This  consists  of  pouring  four  basinfuls  of  water  at 
90°  F.  (32.2°  C),  previously  held  in  readiness,  over  the  body. 
Water  is  dipped  from  a  vessel  and  poured  with  force  over  each 
shoulder,  the  back,  and  front  of  the  chest.  Rapid  drying  while 
standing  on  a  warm  towel  completes  the  procedure.  Beginning 
with  a  water  treatment  at  90°  F.  r32.2°  C.)  it  is  reduced  daily 
•  by  a   few  degrees   until  60°   or   50°  F.  (15.6°  or  10°  C.)  is 


TUBERCULOSIS 


97 


reached.  This  refreshing  process  may  be  repeated  daily.  In 
febrile  cases  Dr.  Baruch  states  that  the  temperature  should  not 
fall  below  65°  F.  (18.3°  C). 

At  the  Adirondack  Cottage  Sanitarium,  Dr.  Lawrason  Brown 
states  in  a  private  communication  to  the  author  that  some  of  the 
patients  throughout  the  winter  take  cold  sponges  and  some  cold 
plunges,  but  he  does  not  advocate  very  strongly  a  plunge  into 
such  cold  water  as  flows  from  the  faucets  in  winter,  in  the  neigh- 
borhood of  40°  F.  (4.5°  C).    His  patients  are  treated  usually 


Fig.  23.— Morning  douche  of  cold  water.  The  tuberculous  patients  at  the 
Pine  Ridge,  R.  I.,  sanatorium  or  camp  were  accustomed  to  take  this  douche. 
Photograph  taken  in  March,  1905,  for  the  author,  by  Dr.  W.  H.  Peters. 


along  the  Hues  laid  down  in  Dr.  Bro\vn's  chapter  on  the  treat- 
ment of  pulmonary  tuberculosis  in  Osier's  "Modern  Medicine," 
vol.  iii,  but  such  measures  are  not  advised,  except  in  a  very 
moderate  form,  if  there  be  heart  disease,  aneury^sm,  or  marked 
arteriosclerosis. 

The  bath  should  be  taken  in  a  room  never  below  55°  F. 
(12.8°  C),  and  the  lower  half  of  the  body  should  be  kept  clothed 
while  the  upper  half  is  being  cleansed  with  water  at  100°  F. 
(37.8°  C).  Cold  water,  40°  to  60°  F.  (4.5°-15.6°  C),  should 
be  applied  with  a  sponge  to  the  neck,  to  the  front  and  back  of  the 

7 


98  HYDROTHERAPY 

chest,  and  to  the  arms  for  from  one  to  two  minutes.  The  body 
is  then  dried  with  a  coarse  towel.  In  cases  unaccustomed  to  a 
morning  bath,  it  will  be  best  to  use  tepid  water  at  80°  to  100°  F. 
(26.7°-37.S°  C.)  instead  of  sponging  at  40°  to  60°  F.  (4.5°- 
15.0°  C),  gradually  reducing  the  temperature  each  day  until 
the  latter  temperatures  are  reached.  In  other  cases  it  is  best  to 
begin  with  sponging  one  arm,  then  on  the  following  day  both 
arms,  and  so  on  until  the  body  to  the  waist  has  been  sponged. 
Alcohol  rubs  or  salt  rubs  may  be  substituted  in  special  cases. 
For  more  vigorous  patients  the  cold  i)lungc  at  50°  to  70°  F. 
(10°-21.1°  C.)  may  be  permitted,  or  the  cold  shower,  or  the 
full  cold  sponge  while  standing  in  warm  water.  In  winter 
these  meaures  are  to  be  modified  if  they  increase  nervousness. 
These  morning  baths  and  sponges,  however,  are  in  no  sense  a 
substitute  for  a  bath  twice  a  week  in  water  at  100°  to  105°  F. 
(37.8°^0.6°  C.)  with  a  free  use  of  soap. 

In  febrile  cases  great  care  should  be  taken  to  avoid  any 
exhausting  hydrotherapeutic  measure.  Dr.  Brown  advises  a 
salt  sponge  in  the  evening,  followed  by  an  alcohol  rub.  This 
refreshes  the  patient  and  induces  sleep.  If  the  patient  be  weak, 
alcohol  may  be  added  to  the  salt  water.  If  the  sponges  fail  to 
reduce  the  temperature  sufficiently,  an  ice  rub  may  be  given  or  a 
cold  pack  to  the  trunk.  An  ice-bag  over  the  heart  frequently 
quiets  the  nervous  system.  If  patients  fail  to  react  or  feel 
chilly,  it  will  be  well  to  try  dry  rubbing  and  on  subsequent  days 
sponging  with  warm  water,  gradually  reducing  the  temperature. 
A  little  food  or  hot  drink  should  be  given  before  the  morning 
bath.  In  sponging  with  salt  water,  ^  ounce  of  salt  to  the  quart 
of  water  will  be  sufficient. 

Advanced  febrile  cachectic  patients,  or  those  with  a  tend- 
ency to  hemoptysis,  should  never  be  sent  to  a  spa;  but  saline 
waters,  such  as  Congress  or  Hathorn,  are  sometimes  valuable  in 
relieving  the  catarrh  of  quiescent,  torpid,  or  anemic  patients. 

When  cough  is  distressing,  a  local  cold  compress  to  the  chest 
is  useful.  The  cross-binder  of  Priessnitz  and  Winteniitz  may  be 
applied  during  the  night  to  relieve  pleuritic  pains,  bronchial 


TUBERCULOSIS  99 

catarrh  with  tenacious  sputum,  and  persistent  cough.  Sleep  is 
thus  favored. 

The  cross-binder  is  applied  as  follows :  Take  several  strips  of 
linen  or  cotton  cloth  3  or  4  inches  wide  and  20  to  24  inches  long. 
Dip  in  cold  water,  pass  over  each  apex,  and  hold  in  place  by  a 
strip  6  to  9  inches  wide  encircling  the  chest.  These  strips  should 
be  covered  with  a  3-inch  flannel  bandage  closely  applied.  Oiled 
paper,  musHn,  or  silk  may  be  used  under  the  flannel  bandage, 
but  it  is  not  necessary.  "When  removed  in  the  morning  the  chest 
should  be  sponged  with  cold  water.  If  patients  do  not  react  to 
the  cross-binder,  they  should  be  rubbed  with  or  without  alcohol 
until  warm  before  reapplying  the  cross-binder. 

Tuberculous  patients  are  liable  to  neurasthenia,  and  hence 
great  tact  is  necessary  in  instituting  new  measures. 

Pulmonary  Hemorrhage. — It  has  long  been  know"n  that  cold 
applied  to  a  distant  part  will  control  a  pulmonary  hemorrhage. 
Currie  (1797)  refers  to  this,  stating  that  he  found  that  hemor- 
rhage from  the  lungs  may  be  stopped  by  immersing  the  feet  in 
cold  water,  or,  better  still,  by  applying  it  permanently  to  the 
scrotum  and  genitals,  "which  part  with  their  heat  more  easily 
than  any  other  portion  of  the  body."  He  also  obtained  a  more 
powerful  effect  by  immersing  the  body  up  to  the  pubes  in  cold 
water. 

Cold  apphcations  by  means  of  ice-bags  may  also  be  made  to 
the  chest  or  to  the  thighs,  this  causing  a  contraction  of  the  pul- 
monary vessels  by  reflex  action.  It  is  the  experience  of  Kraus, 
Brehmer,  and  others  who  have  used  hydrotherapy  in  tuberculosis 
that  hemoptysis  is  never  produced  by  these  measures. 

A  case  was  recently  reported  by  Downes,  in  which  a  man 
lost  by  hemoptysis  as  much  as  153|-  ounces  of  blood  in  nine 
days,  the  greatest  amount  in  one  day  being  31  ounces.  The 
"usual  methods  employed  for  checking  hemoptysis  proved  futile, 
but  immediately  on  applying  an  ice-bag  over  the  suspected 
lung  all  bleeding  stopped,  and  not  a  single  drop  of  blood  was 
expectorated  from  then  on.  All  drugs  were  stoppetl  and  the 
ice-bag  kept  in  place  for  six  days. 


100  HYDROTHERAPY 

PNEUMONIA 

This  disease  has  gradually  taken  first  place  in  the  mortality 
lists  of  our  largest  cities.  In  New  York  City  it  has  been  the 
leading  cause  of  death  for  seventeen  years,  and  for  seventeen 
years  had  been  second  only  to  tuberculosis.  The  methods  of 
treating  pneumonia  have  changed  considerably  in  recent  years, 
and  a  larger  consideration  is  gradually  being  given  hydrothera- 
peutic  methods.  No  matter  what  the  i)lan  adopted  may  be,  the 
mortality  rate  in  hospitals  remains  very  high,  from  30  to  40  per 
cent.,  alcoholic  cases  included.  In  private  practice,  how- 
ever, the  rate  is  much  lower.  Those  who  have  used  hydro- 
therapy, and  especially  cold  applications,  have  met  with  better 
success,  and,  considering  the  extraordinary  reports,  it  is  a  matter 
for  wonder  that  the  methods  adopted  have  not  been  more  gener- 
ally employed. 

Cold. — Without  reviewing  the  use  of  drugs,  venesection,  and 
the  expectant  treatment  that  have  had  more  or  less  popularity, 
we  would  refer  more  particularly  to  the  use  of  cold.  In  pneu- 
monia this  is  applied  by  means  of  ice-bags,  snow,  cold  compresses 
to  the  affected  chest  and  to  the  head,  or  by  means  of  the  Brand 
bath,  as  used  in  typhoid  fever.  The  fact  is  that  pneumonia  and 
typhoid  fever  respond  in  very  much  the  same  manner  to  hydro- 
therapy. Both  these  infections  are  met  by  the  same  reparative 
processes,  the  full  power  of  which  is  brought  out  and  reinforced 
by  thermic  stimulation.  The  fact  that  one  infection  selects  the 
lung  and  the  other  the  intestine  has  nothing  to  do  with  the  pro- 
priety of  similar  methods  of  treatment. 

The  main  object  of  treatment  in  pneumonia  is  the  preserva- 
tion of  the  full  and  efficient  action  of  the;  heart  and  the  peripheral 
circulation.  Heart  failure  is  the  principal  cause  of  death.  In 
all  infectious  diseases  it  should  be  our  aim  to  improve  the  cir- 
culation in  the  cutaneous  arterioles,  and  our  best  agent  is  un- 
doubtedly thermic  stimulation  by  methods  which  will  be  de- 
scribed further  on.  The  danger  of  hyperpyrexia  is  not  so  much 
degeneration  of  the  heart  muscle,  as  interference  with  the  pe- 
ripheral circulation. 


PNEUMONIA  101 

Clinicians  are  constantly  warning  against  the  use  of  drugs 
to  counteract  hyperpyrexia.  Undoubtedly  much  harm  was 
done  during  the  earlier  years  after  their  introduction  and  later 
by  acetanilid  mixtures  masquerading  under  trade  names.  Alco- 
hol, also,  excepting  in  cases  where  the  heart  is  failing,  is  not  em- 
ployed nearly  as  freely  as  formerly,  excepting  in  pronounced 
alcoholic  cases.  Strychnin  has  also  been  abused  in  this  con- 
nection, and  all  these  measures  when  used  to  excess  are  more  or 
less  embarrassing  to  the  struggling  heart.  Remedial  agents 
directed  to  the  skin  and  the  vasomotor  system  are  more  rational, 
and  not  only  prepare  the  way  for  cardiac  stimulants  when  needed, 
but  also  enhance  their  action. 

The  application  of  cold  to  the  thorax  and  to  the  head  profoundly 
affects  the  heat  regulating  centers  of  the  body.  These  are  located 
in  the  cortex  and  at  the  base  of  the  brain.  The  derangement 
of  their  functions  by  the  products  of  infection  produces  fever. 
The  respiratory  centers  share  in  this  derangement,  resulting  in 
the  C|uick  breathing  so  characteristic  of  pneumonia  and  other 
infections,  partly  central  and  partly  reflex  in  its  origin.  When 
the  infection  is  intense  or  when  from  any  cause  the  heat-regulating 
centers  are  unduly  stimulated,  the  neighboring  convulsive  cen- 
ters are  aroused,  giving  rise  to  the  convulsions  of  febrile  diseases. 

The  early  use  of  cold  applications  to  the  head  and  chest  in 
pneumonia  is,  therefore,  demanded  to  mitigate  the  effects  of  the 
toxins  on  the  central  nervous  system.  It  is  conservative: 
while  sparing  the  nerve-centers  it  favors  the  better  distribution  of 
the  blood  in  which  are  generated  those  antitoxins,  and  the  so- 
called  antibodies,  which  swallow  up  the  invader. 

Cold  applications,  therefore,  to  the  brain  and  to  the  base  of 
the  brain  are  rational  in  connection  with  similar  applications 
to  the  thorax.  They  reduce  restlessness  and  irritability  or  pre- 
vent them  altogether,  and  reinforce  the  effect  of  cold  applied  to 
the  chest. 

Dr.  Thomas  J.  Mays,^  of  Philadelphia,  seventeen  and  eigh- 

1  Medical  and  Surgical  Reporter,  Dec.  19,  1906.  See  also  Med.  News, 
Philadelphia,  Sept.  24,  1892;  June  24,  1893;  Oct.  13,  1894. 


102 


HYDROTHERAPY 


teen  years  ago  published  reports  on  the  local  application  of  cold 
in  acute  pneumonia  with  an  analysis  of  299  cases  treated  in  this 
manner  by  physicians  residing  in  nearlj'^  all  parts  of  the  United 
States.  This  was  a  remarkable  collection,  as  the  cases  were  dis- 
tributed from  the  Atlantic  to  the  Pacific  coast,  and  only  10  deaths 
were  reported,  the  death  rate  being  3.35  per  cent. 

Of  course,  in  a  collective  investigation  of  this  kind,  where 
reports  are  requested,  the  tendency  is  to  bring  forward  successes 
and  withhold  failures,  so  that  some  allowance  must  be  made  for 
the  natural  tendency  of  the  human  mind  to  respond  with  favor- 


Fig.  24 


-Application  of  the  cold-water  coil   to  the  cljist   in  crouixnis  pneumonia 
or  pleurisy.     Leiter  coil  (Hare.) 


able  data  on  a  given  subject.  But  with  all  due  allowance  for  the 
natural  tendency  to  bias  in  such  a  collective  investigation,  a  most 
favorable  conclusion  is  reached  as  to  the  value  of  the  local  applica- 
tion of  cold  in  acute  pneumonia. 

As  an  evidence  of  the  character  of  the  cases  in  which  cold  was 
used,  ice  being  the  medium  employed,  and  in  testimony  to  the 
favorable  impression  both  on  the  part  of  the  patients  and  their 
physicians,  Dr.  Mays  published  an  additional  report  of  195 
cases  with  7  deaths.* 

1  The  Local  Application  of  Cold  in  Acute  Pneumonia,  by  Thomas  J.  Mays, 
Trans.  Phila.  County  Med.  Soc,  vol.  xvi,  1895. 


PNEUMONIA  103 

In  the  pneumonia  of  infants  and  young  children  a  moder- 
ately cool  wet  pack  is  useful  (see  p.  340).  Coof  spongings  are 
sometimes  employed,  but  thej'-  require  manipulation  and  are 
more  likely  to  disturb  the  patient  than  is  the  pack.  They  are  in- 
effective if  there  be  a  high  temperature.  It  should  be  distinctly 
understood  both  in  reference  to  children  and  adults  that  natural 
sleep  is  not  to  be  disturbed  by  any  hydrotherapeutic  measures. 
Ice-bags  have  the  advantage  of  causing  less  interference  with  the 
bodily  comfort  and  quiet  of  both  children  and  adults,  and  are  used 
successfully  with  children  as  young  as  two  or  three  years,  taking 
care  that  the  bag  is  not  applied  directly  to  the  skin.  The  ice- 
bags  must  also  be  removed  at  intervals  to  avoid  local  cyanosis, 
for  on  rare  occasions  devitalization  of  the  parts  to  which  they 
have  been  applied  has  occurred.  One  such  case  is  recorded  in 
France,  and  recently  a  suit  for  damages  has  been  brought  in  which 
it  is  alleged  that  proper  precautions  were  not  taken  to  prevent 
this  accident.     (See  page  386.) 

Dr.  B.  Buxbaum,^  of  Vienna,  is  a  strong  advocate  of  cool 
half -baths  at  65°  to  72°  F.  (18.3°  to  22.2°  C.)  for  not  over  five 
minutes,  with  active  frictions  and  affusions.  He  also  uses  the 
chest  compress  or  cross-binder  (Stammumschlage)  and  warm 
packs  to  the  lower  extremities.  The  chest  compress  is  put  on 
cold  and  changed  every  two  or  three  hours.  He  rightly  insists 
that  it  is  not  the  high  temperature  that  must  be  combated,  but 
the  weakness  of  the  heart,  the  nerve  changes,  the  congestion,  and 
hyperemia  of  the  lung. 

The  best  treatment  of  very  young  children  is  by  cold  com- 
presses or  sponging.  The  compresses  should  be  wrung  out 
of  water  at  75°  to  80°  F.  (23.3°-26.7°  C).  If  sponging  is 
adopted  and  the  child  does  not  react  from  a  cold  sponge,  a  luke- 
warm sponge  should  be  given.  In  some  cases  it  will  be  impos- 
sible to  sponge  at  all,  and  then  compresses  are  usually  better 
borne.    They  should  be  applied  from  the  neck  to  the  umbilicus. 

1 B.  Biixbaum,  Die  Hydrotherapie  der  Pneumonien  im  Kindesalter, 
Deutsche  Medizinal  Zeitung,  Feb.  4,  1897;  and  Blatter  f.  klin.  Hydrotherapie, 
8,  1896. 


104  HYDROTHERAPY 

A  full  wet  pack  is  also  sometimes  used  with  success.  It  adds  to 
the  child's  comfort,  improves  sleep,  diminishes  the  respiration, 
and  strengthens  the  heart.  The  Brand  bath  is  not  to  be  recom- 
mended in  children. 

In  adults  the  compresses  should  be  colder  and  the  following 
procedure  is  advised :  A  large  towel  maybe  folded  lengthwise  in 
the  middle,  then  crosswise  in  the  middle.  One-half  of  the  length 
of  this  four-ply  towel  is  wrung  tightly  from  ice- water  or  the  coldest 
water  obtainable,  and  again  folded  crosswise,  so  as  to  give  four 
thicknesses  of  wet  towel  inside  and  the  same  of  dry  towel  outside 
when  applied  to  the  chest.  The  damp  folds  should  be  freshened 
as  often  as  they  become  the  least  hot,  whether  this  be  in  ten, 
twenty,  oi-  thirty  minutes.  Probably  at  first  in  severe  cases 
changes  will  be  as  often  as  eight  or  ten  minutes,  the  intervals 
lengthening  more  and  more  as  the  inflammation  subsides,  and 
breathing  consequently  becomes  deeper  and  easier.*  As  the 
breathing  becomes  more  natural  and  the  compress  fails  to  become 
hot,  the  applications  may  cease.  The  ice-bag  should  be  applied 
if  pain  is  persistent.  Abundance  of  water  should  be  given  inter- 
nally; if  not  borne  by  the  mouth,  enemas  may  be  substituted. 

When  the  secretions  are  checked  and  the  skin  hard  and  dry, 
with  the  tongue  dry  and  brown,  the  pulse  weak  and  rapid,  and 
the  respiration  shallow  and  quick,  and  subsultus  indicates  depres- 
sion, great  benefit  may  sometimes  be  obtained  from  the  adminis- 
tration by  hypodermocylsis  or  high  rectal  enemas  of  ^  to  1  pint 
of  decinormal  salt  solution,  or,  better,  the  normal  salt  solution 
to  which  has  been  added  a  small  cjuantity  of  a  calcium  salt. 
Ringer's  solution  may  be  employed  for  the  purpose.  It  con- 
sists of  a  1  per  cent,  solution  of  calcium  chlorid,  3  parts;  a  1  per 
cent,  solution  of  potassium  chlorid,  4  parts;  a  1  per  cent,  solu- 
tion of  sodium  clilorid,  70  parts;  and  distilled  water,  23  parts." 

In  dealing  with  an  infection  like  pneumonia  every  effort 
should  be  made  to  get  rid  of  the  toxins  and  prevent  any  exten- 

1  C.  E.  Page,  Medical  Record,  December  23,  1905. 

*  See  Prognosis  and  Treatment  of  Croupous  Pneumonia,  Jour.  Amer.  Med. 
Assoc,  Nov.  22,  1902. 


PNEUMONIA  105 

sion  of  the  bacterial  invasion.  Fortunately,  relapse  is  rare  in 
pneumonia,  and  this  is  an  evidence  that  natural  protective  anti- 
toxins are  usually  sufficient  to  limit  the  disease  at  least  to  one 
lung.  In  promoting  elimination  we  should  pay  more  attention 
to  the  skin  and  bowels  than  to  the  kidneys,  as  there  is  always 
danger  that  the  circulation  may  fail.  In  acting  on  the  skin 
we  may  supplement  the  action  of  a  faihng  heart,  and  hence 
measures  that  promote  sweating  are  not  only  safe,  but  impera- 
tively demanded.  They  may  be  used  in  connection  with  the 
cold  applications  to  the  chest  which  we  have  referred  to.  To 
promote  sweating  is  to  facilitate  nature's  method  of  combating 
infectious  diseases.  In  connection  with  a  free  action  of  the 
bowels  it  is  an  aid  to  recoveiy.  A  most  rational  method  of 
treatment  has  been  practised  by  Dr.  De  Lancey  Rochester  with 
great  success.^  We  give  his  method,  which  he  has  earnestly 
advocated  for  many  years  and  wliich  is  well  worth  attention. 
The  first  indication  is  to  relieve  toxemia;  the  second,  to  prevent 
failure  of  the  heart;  the  third,  to  prevent  complications  as  they 
arise. 

As  already  stated,  we  should  not  attempt  to  stimulate  the 
kidneys  to  excessive  action,  especially  if  in  a  state  of  acute 
inflammation.  This  is  worse  than  useless,  so  the  use  of  stimu- 
lating dim'etics  is  positively  contraindicated. 

The  bowel  and  the  skin  remain,  and  nature  has  shown  by 
the  profuse  sweat  at  crisis  and  the  occasional  critical  diarrhea 
that  these  are  the  avenues  that  are  prefer;red. 

So  our  first  indication  in  treatment,  the  rehef  of  toxemia, 
may  be  met  by  induced  sweats  and  mild  catharsis.  The  mild 
catharsis  is  best  produced  by  the  administration  of  calomel  at 
the  onset  of  the  disease,  to  be  followed  by  the  use  of  a  saturated 
solution  of  Epsom  salts  in  moderate  dose  daily.  The  calomel 
dose  may  be  repeated  occasionally  as  the  indications  arise.  The 
sweating  is  best  and  most  easily  induced — ^not  by  the  administra- 
tion of  drugs — but  by  the  hot  mustard  foot-bath  scientifically 

1  Medical  News,  February  13,  1904;  Jour.  Amer.  Med.  Assoc,  November 
9,  1901. 


106  HYDROTHERAPY 

given  in  bed  with  no  disturbance  of  the  patient.     Much  depends 
upon  the  i)rop(>r  niethotl  of  giving  this  bath. 

The  patient,  in  a  nuele  condition,  lies  between  blankets  with 
his  knees  flexed,  his  feet  in  the  tub  which  has  been  introduced 
under  the  upper  blanket,  the  long  axis  in  the  line  of  the  patient's 
body  and  legs;  another  blanket  passes  from  under  the  tub  up 
over  the  end  and  over  the  knees  of  the  patient;  two  to  five 
blankets  or  a  smaller  number  of  blankets  and  a  rubber  sheet 
are  then  placed  over  the  patient,  extending  from  the  neck  of  the 
patient  over  the  foot  of  the  bed  and  tucked  in  around  the  foot- 
tub  and  side  of  the  patient.  The  tub  at  first  is  filled  half  full  of 
hot  water  in  which  a  heaping  tablespoonful  of  mustard  has  been 
dissolved.  From  time  to  time  during  the  bath  more  hot  water 
is  added,  care  being  taken  that  the  water  is  poured  against  the 
side  of  the  tub  and  stirred  in  by  the  hand  of  the  nurse,  in  order 
to  avoid  burning  the  patient's  feet.  The  bath  is  k(>pt  up  from 
thirty  to  forty-five  minutes,  according  to  the  amount  of  sweating 
produced.  During  the  administration  of  the  bath  cloths  wrung 
out  of  ice-water  are  kept  constantly  on  the  head  of  the  patient. 
This  sweating  in  connection  with  the  stimulation,  to  be  referred 
to  later,  is,  in  Dr.  Rochester's  opinion  and  that  of  the  writer,  the 
most  important  of  the  general  therapeutic  measures. 

In  treating  pneumonia,  just  as  in  the  case  of  typhoid  fever, 
we  must  recognize  again  the  remedial  power  of  fever,  and  not  be 
in  too  much  haste  to  check  it  by  intense  hydrotherapeutic 
measures.  The  toxemia  of  pneumonia  is  rarely  so  intense  as  in 
typhoid;  moderate  fever  is  not  fraught  with  danger,  and  unless 
the  temperature  exceeds  103°  F.  (39.5°  C)  it  probably  aids  the 
destruction  of  the  specific  virus.  Indeed,  it  has  been  claimed 
that  cases  of  loljar  pneumonia,  in  which  the  temperature  pursues 
a  comparatively  low  range,  do  badly  as  compared  with  more 
febrile  symptoms.    This,  however,  we  do  not  fully  believe. 

Dr.  Jacobi  says  of  high  temperatures :  It  is  understood  that 
a  high  temperature  is  not  a  uniform  danger.  In  persons  suffer- 
ing from  an  old  heart  disease,  in  the  prematurely  born,  in  the 
anemic  of  all  ages,  it  is  so,  or  may  be.     Whether  a  warm  bath, 


PNEUMONIA  107 

or  a  warm  bath  gradually  cooled  down,  or  a  cold  bath,  or  cold 
washing  and  sponging  and  friction,  or  a  warm  or  a  cold  pack 
over  chest  and  abdomen  are  indicated,  or  the  local  application 
of  an  ice-bag,  depends  on  the  individual  case  and  the  individual 
doctor.  Forty  years  ago  ^  I  could  speak  of  a  fair  experience 
with  cold  water  in  typhoid  fever,  pneumonia,  scarlatina,  variola, 
ophthalmia,  diphtheria  of  the  conjunctiva,  heart  diseases,  local 
inflammation,  phlegmon,  synovitis,  and  peritonitis.  It  has 
served  me  well  since.  No  uniform  rules  fitting  every  case  of 
pneumonia  can  be  given.     It  takes  brains  to  treat  lungs. 

Delearde  gives  revulsion  as  the  primary  indication  in  the 
treatment  of  bronchopneumonia  and  capillary  bronchitis  in 
children.  It  should  be  applied  energetically  four  times  every 
twenty-four  hours  throughout  the  diseases  until  the  faU  of 
temperature  and  the  disappearance  of  the  principal  signs.  The 
methods  recommended  are  sinapisms  and  hydrotherapeutics. 
The  mustard  leaf  may  be  made  use  of,  but  a  much  more  effective 
application  is  made  by  wringing  out  a  napkin  in  a  thin  mustard 
paste  and  enveloping  the  chest  in  it.  The  child  is  then  wrapped 
in  flannels  and  left  for  fifteen  minutes.  After  this  he  is  un- 
wrapped and  bathed  in  warm  water  to  remove  the  loose  mustard, 
and  dressed  and  put  to  bed,  when  he  usually  goes  to  sleep  com- 
fortably. This  should  be  repeated  two  or  three  times  in  twenty- 
four  hours.  The  rubefacient  effect  lasts  several  hours.  The 
mustard  bath  also  produces  a  good  revulsive  effect.  This  form 
of  application  is  appropriate  when  the  extension  of  the  lesion 
gives  us  a  bad  prognosis,  rather  than  degree  of  the  infection. 
Two  sinapisms  and  four  hot  baths  at  38°  C.  (100.4°  F.)  may  be 
given  daily.  When  the  involvement  is  small  in  area  and  the 
infection  severe  the  prostration  would  be  increased  by  hot  baths, 
while  cold  baths  wiU  lessen  it  and  stimulate  the  child,  lessen  pulse 
tension,  and  increase  diuresis.  Cold  packs  have  the  same  effect. 
When  natural  sleep  occurs,  no  hydrotherapeutic  measures  ought 
to  be  used. 

1  Med.  Record,  1870. 


108  HYDROTHERAPY 

ASPHYXIA    NEONATORUM 

Asphyxia  neonatorum  calls  for  hydriatric  measures.  The 
child  should  be  given  rather  vigorous  vibrations,  swinging  or 
shaking  movements,  rubbing  the  chest  with  cloths  wet  in  warm 
water,  claj^ping  the  soles  of  the  feet.  Efforts  should  also  be 
made  to  get  the  nmcus  from  the  throat,  and  the  child  should  be 
placed  in  a  warm  bath  at  90°  F.  (32.2°  C).  The  bath  should  be 
of  short  duration,  varied  with  cool  douches  or  clashes  of  cool 
water.  After  repeated  efforts,  slight  and  irregular  breathing 
may  be  established  in  cases  which  will  not  yield  to  other  measures. 
As  the  efforts  are  continued,  the  breathing  is  gradually  estab- 
lished. 

ACUTE  BRONCHITIS 

In  acute  bronchitis  the  hot  mustard  foot-bath  or  full  bath, 
described  on  pp.  106  and  291,  should  be  tried.  A  time-honored 
measure  is  the  Priessnitz  pack  or  cross-pack  about  the  whole 
chest.  It  relieves  pain  and  especially  dyspnea  and  cough. 
The  pack  should  be  made  from  water  at  45°  to  55°  F.  (7.2°- 
12.8°  C.)  and  renewed  every  two  hours  by  day,  but  may  be  left 
unchanged  at  night  in  order  not  to  disturb  rest,  renewing  as 
opportunity  offers.  For  adults,  cold  douches  to  the  chest  may 
be  used. 

Steam  Douche  to  Promote  Ex-pedoration. — Lissauer  *  has  been 
using  for  a  year  a  method  of  stimulating  the  secretions,  which 
has  proved  very  effectual  and  harmless  in  his  hands.  A  spray 
of  steam  at  a  temperature  of  from  110°  to  125°  F.  (43°-52°C.) 
is  sprayed  rapidly  over  the  upper  part  of  the  body  for  fifteen 
seconds,  followTd  by  a  cold  fan  douche  for  three  or  five  seconds, 
after  w^hich  the  patient  is  rapidly  rubbed  down  and  dressed. 
He  cites  16  cases  in  detail  to  show  the  prompt  effect  on  the 
expectoration  induced  by  this  procedure.  It  does  not  produce 
much  of  an  appreciable  reaction  on  the  skin,  but  the  patients  feel 
the  relief  very  soon. 

Mustard  Packs  i7i  Bronchitis. — Mustard  may  be  used  as  a 

^  Deut.  Med.  Wochenscrift,  xxxii,  No,  7. 


ACTIVE   CONGESTION   OF   THE   LUNG  109 

counterirritant  in  the  treatment  of  capillary  bronchitis  and  bron- 
chopneumonia in  infants  and  children.  Dr.  A.  Herzfeld,  of  New 
York,  has  been  using  a  method  devised  by  him  for  the  past 
thirteen  years  with  great  advantage.  It  is  as  follows :  250  ccm. 
of  water  and  250  ccm.  of  alcohol  are  mixed  in  a  large  bowl;  to 
this  are  added  from  25  to  50  ccm.,  according  to  the  severity  of 
the  case,  of  freshly  prepared  spirit  of  mustard.  The  spirit  of 
mustard  is  prepared,  according  to  the  German  Pharmacopoeia, 
as  follows:  Oil  of  mustard,  1  part;  pure  alcohol,  49  parts.  A 
large  piece  of  flannel  is  moistened  with  the  mixture  and  wrapped 
around  the  child  from  the  neck  to  the  knees.  The  child  is  then 
enveloped  in  a  dry  sheet,  and  the  pack  is  left  on  until  the  skin 
is  a  bright  red,  usually  in  from  fifteen  to  thirty  minutes.  The 
child  is  then  taken  out  and  wrapped,  and  left  for  another  half- 
hour  in  a  pack  wet  with  1  part  alcohol  and  2  parts  water.  At 
the  end  of  this  time  the  child  is  wrapped  in  a  dry  sheet.  Usually 
one  pack  causes  marked  improvement,  but  relapses  are  frequent, 
and  it  may  need  renewal.  Once  in  twenty-four  hours  is  enough 
unless  the  indications  are  unavoidable.  The  physician  should 
apply  the  first  pack  himself,  to  determine  the  strength  needed, 
and  to  instruct  the  parent  or  nurse.  Dr.  Herzfeld  sums  up  the 
advantages  of  the  method  as  follows :  It  is  surprisingly  rapid  in 
effect.  Its  light  weight  does  not  materially  embarrass  respira- 
tion. It  can  be  appUed  without  removing  the  enfeebled  patient 
from  the  bed.     It  is  inexpensive.     It  is  clean.^ 

ACTIVE  CONGESTION  OF  THE  LUNG 

In  active  congestion  of  the  lung,  without  evidence  of  an  on- 
coming pneumonia  or  other  serious  disease,  the  overfilling  of 
the  blood-vessels  may  often  be  corrected  by  hot  applications  and 
counterirritants.  Many  clinicians  use  a  hot  bath  at  106°,  108° 
or  110°  F.  (41.1°,  42.2°,  or  43.3°  C.)  for  ten  minutes.  The  warm 
pack  may  be  used,  and,  if  necessary,  this  may  be  preceded  by  a 
hot  bath.     If  the  two  measures  are  used,  the  bath  may  be  short- 

1  Jour.  Amer.  Med.  Assoc,  January  9,  1909. 


110  HYDROTHERAPY 

ened  to  hxc  or  six  minutes.     It  is  best  to  bring  the  bath  gradually 
up  to  the  maximum  after  the  patient  is  in  the  tub. 

Sweating  processes  are  indicated  as  described  in  the  treatment 
of  pneumonia  (see  pp.  105  and  10(3). 

EDEMA  OF  THE  LUNG 

In  edema  of  the  lung  the  mustard  pack  is  highly  recommended 
by  Lenhartz,  applied  after  the  following  plan:'  1  to  3  pounds 
of  mustard'  are  taken  antl  a  i^ap  is  made  by  the  addition  of  a 
sufficient  quantity  of  lukewarm  water.  This  is  spread  upon  a 
sheet,  laid  upon  a  blanket,  and  the  patient  is  then  wrapped  up 
in  both,  so  that  the  extremities,  trunk,  and  neck  are  thorouglily 
covered,  the  eyes  being  protected  from  the  fumes  by  tucking  the 
blanket  in  at  the  chin. 

The  patient  remains  in  the  pack  from  twenty  to  thirty  minutes 
and  is  then  washed  off  with  lukewarm  water. 

Carbonic  acid  baths  ought  not  to  be  given  w^hen  there  is  any 
tendency  to  pulmonary  edema. 

INFLUENZA,  EPIDEMIC  CATARRHAL    FEVER 

In  this  disease  hot  applications  give  more  relief  than  cold  ones. 
They  should  take  the  form  of  hot  or  warm  baths;  and  the  use  of 
cold  cloths  to  the  head,  whether  in  or  out  of  the  bath,  should 
be  repeated  in  accordance  w4th  the  comfort  afforded. 

ASTHMA 

Bronchiala  stliina  due  to  nasal  reflex  is  amenable  to  treat- 
ment by  cold  ai)i)lic'ations.  Cokl  water  may  be  poured  over  the 
back  of  the  neck  or  applied  in  the  form  of  a  cold  douche  under  a 
pressure  of  10  or  12  pounds  and  for  only  a  few  seconds.  This 
is  an  application  of  the  principle  enunciated  by  Winternitz; 
namely,  that  the  use  of  cold  or  heat  by  reflex  action  modifies  the 
lumen  of  the  blood-vessels  through  the  vasomotor  and  respira- 

^  The  Prophylaxis  and  Treatment  of  Internal  Diseases,  Forchheimer, 
p.  340. 


SWEATING  111 

tory  centers.  The  same  effect  is  not  realized  by  the  application 
of  cold  elsewhere  on  the  body  nor  by  mere  cloths  wrung  out  of 
hot  water.  The  mechanical  stimulus  of  the  poured  water 
seems  to  be  an  important  element  in  the  relief  experienced. 

Before  dressing  in  the  morning  the  simple  application  of  the 
cold  douche  to  the  back  of  the  neck  gives  great  relief  in  chronic 
simple  rhinitis,  and  may  relieve  the  suffocation  in  asthma. 

RENAL  DISEASES 

The  use  of  hydrotherapy  in  renal  diseases,  especially  in  con- 
junction with  the  administration  of  water  internally,  has  held  a 
well-deserved  place  in  therapeutics  for  ages.  Nearly  every  spa 
and  every  mineral  water  has  been  advocated  for  this  class  of 
affections.  But  the  forms  of  renal  disease  are  so  various  and  the 
different  stages  of  the  same  affection  exhibit  such  different 
pathologic  conditions  that  the  subject  seems  to  become  more 
complicated  and  more  confused  as  more  light  is  thrown  upon  it. 
Physiologists  and  clinicians  are  by  no  means  agreed  on  some  of 
the  main  points  involved  in  the  hydrotherapy  of  renal  disease, 
points  on  which  great  stress  is  usually  laid  in  explaining  the 
action  of  the  baths. 

SWEATING 

Aside  from  the  subject  of  the  use  of  waters  internally, 
allied  so  closely  to  hydrotherapy  and  about  which  there  is  a 
radical  difference  of  opinion,  the  action  of  water  on  the  skin 
involves  questions  on  which  well-known  authorities  differ.  It 
is  commonly  believed  that  the  sweating  process  which  precedes, 
accompanies,  or  succeeds  the  bath,  while  relieving  the  kidneys 
of  some  of  their  functions,  carries  off  in  the  sweat  certain  toxic 
substances,  thereby  causing  the  skin  to  eliminate  what  the  dis- 
eased kidney  is  unable  fully  to  accomplish.  In  other  words,  the 
skin  acts  vicariously  for  the  kidneys  as  an  excretory  organ.  But 
this  view  is  not  accepted  by  some  of  those  most  competent  to 
judge,  and  such  men  as  Senator  and  von  Noorden,  in  Europe, 
and  Croftan  and  Ransom,  in  America,  are  on  record  as  opposed 


112  HYDROTHERAPY 

to  this  theory.*  Senator  says:  "Warm  baths  are  useful  in 
removing  excess  of  water,  but  the  specific  urinary  constituents, 
which  are  the  mischief  maimers,  are  not  removed  in  any  appre- 
ciable ( quantity  even  by  the  most  profuse  sweating,"  von 
Noorclen  holds  that  the  only  benefit  of  sweating  lies  in  the  with- 
drawal of  water  from  the  blood  and  tissues.  He  and  his  puj^ils 
have  demonstrated  that  the  perspiration  of  ncphritics  contains 
only  a  trace  of  urea — the  maxinmm  is  about  1  to  1.3  gm.  in  the 
total  quantity  of  profuse  sweat,  while  the  remaining  constituents 
are  but  harmless  substances.  He  further  states  that  poisonous 
substances  in  the  sweat  have  never  been  found.  Both  von 
Noorden  and  Croftan  express  themselves  decidedly  against  the 
practice  of  giving  large  amounts  of  fluid  during  the  sweating 
process,  considering  it  both  irrational  and  harmful.  "It  is  im- 
possible to  eliminate  any  toxic  substances  in  this  manner;  the 
existing  edema  is  not  relieved  and  may  be  increased,  thereby 
adding  to  the  burden  of  the  enfeebled  cardioAascular  system; 
and,  finally,  the  kidneys  are  in  danger  of  being  further  irritated 
in  the  endeavor  to  excrete  the  excess  of  ingested  water"  (Ran- 
som). 

On  the  other  hand,  Winternitz  says  in  this  connection :  "The 
secretion  of  sweat  certainly  undergoes  considerable  augmenta- 
tion. The  small  amount  of  organic  matter  eliminated  at  the 
same  time,  the  trace  of  urea,  the  various  fatty  acids,  and  the 
numerous  aromatic  substances,  as  well  as  gases,  particularly 
carbon  dioxid,  should  certainly  be  given  consideration  in  this 
connection.  That  toxic  substances,  probably  various  kinds  of 
infectious  matter,  and  even  micro-organisms,  may  leave  the  body 
with  the  sweat,  has  already  been  demonstrated  by  numerous 
investigators.  The  depurative  action  of  the  sweat  is  in  this  way 
revived  in  the  modern  sense.  "^ 

The  experiments  of  Frey  and  Heiligenthal  at  the  sodium 

»A.C.  Croftan,  Jour.  Amer.  Med.  Assoc,  June  24,  1905;  C.  C.  Ransom, 
ibid.;  Senator,  ibid.,  1906;  von  Noorden,  Nephritis,  English  translation,  E.  B. 
Treat  &  Co.,  1905,  pp.  48  and  56. 

2  A  System  of  Physiologic  Therapeutics,  vol.  ix,  p.  37,  by  Wilhelm  Win- 
temitz,  P.  Blakiston's  Son  &  Co.,  Philadelphia. 


SWEATING  113 

chlorid  springs  at  Baden-Baden,  where  steam  baths  are  given  at  a 
temperature  of  122°  F.  (50°  C.)  for  half  an  hour,  are  here  of  in- 
terest. These  experimenters  noticed  a  primary  brief  transitory 
contraction  of  the  capillaries  of  the  skin,  and,  as  a  result,  increased 
pressure  in  the  arterial  system  and  moderate  acceleration  of  the 
pulse;  then  a  secondary  dilatation  of  the  capillaries,  reduction  in 
blood-pressure  and  cardiac  vigor,  and  further  acceleration  of  the 
pulse.  Perspiration  occurred  in  the  bath.  On  the  days  of  the 
bath  there  was  a  reduction  in  the  amount  of  urine,  an  increase  in 
the  elimination  of  urea  and  uric  acid  on  the  first  day,  and  an 
increase  in  this  ehmination  on  the  next  succeeding  days.  Beneke 
has  shown  that  cold  sea-baths  increase  the  elimination  of  urea. 

Although  in  a  case  of  extreme  sweating  as  much  as  1.3  gm. 
of  urea  have  been  recovered  from  the  sweat,  as  a  rule  the  skin 
does  not  excrete  toxic  substances,  but  the  essential  waste  prod- 
ucts are  passed  off  through  the  urine  and  the  bowels.  The  credit 
of  secretion  belongs  almost  entirely  to  the  liver  and  the  kidneys. 

The  beneficial  effect  of  sweating  lies  in  the  removal  of  an  ex- 
cess of  water,  thereby  relieving  the  circulation  of  an  added  burden 
during  the  time  the  kidneys  are  congested.  When  these  organs 
resume  their  function,  it  is  probably  unwise  to  continue  diaphore- 
sis with  the  hope  of  reducing  the  albuminuria.  Ransom  says 
that  sweating  has  no  effect  whatsoever  in  lessening  the  albu- 
minuria, as  the  debilitating  effect  of  the  profuse  sweating  will  not 
be  compensated  for  by  any  good  that  may  come  from  it.  Besides, 
when  the  kidneys  become  active,  it  is  best  to  have  the  urine  as 
little  concentrated  as  possible,  in  order  to  reduce  the  possibility  of 
irritation  from  the  increase  of  solid  matters. 

Ransom  further  holds  that  patients  suffering  from  acute 
nephritis  and  chronic  nephritis  of  the  parenchymatous  form 
should  not  be  sent  to  the  springs.  The  various  hydrotherapeutic 
procedures  which  are  useful  in  the  treatment  of  acute  cases  are 
easily  carried  out  at  home,  and  none  of  the  advantages  obtained 
from  the  spa  treatment  for  chronic  nephritis  results  to  patients 
in  the  acute  forms  of  the  disease.* 

^  See  von  Noorden  on  Nephritis,  op.  cit. 


114  HYDROTHERAPY 

CHRONIC   INTERSTITIAL  NEPHRITIS 

We  thus  see  that  by  the  exclusion  of  the  above-mentioned 
classes  we  have  left  the  cases  of  chronic  interstitial  nephritis 
regarding  the  hydrotherapeutic  treatment  of  which  all  authori- 
ties agree.  It  is  pre-eminently  in  the  case  of  the  gouty  type  in 
which  cardiovascular  changes  have  preceded  the  actual  changes 
in  the  kidney  that  baths  will  do  most  good.  These  patients 
complain  of  circulatory  disturbances,  gastric  disorders,  gradual 
loss  of  strength,  and  anemia.  The  urine  has  a  low  specific  grav- 
ity, is  abundant  in  quantity,  and  deficient  in  urea.  Albumin 
and  hyaline  casts  are  present.  Patients  of  this  type  may  have 
a  high  arterial  tension,  but  this  fact  need  not  debar  them  from 
the  use  of  baths  under  proper  precautions. 

Carbon  dioxid,  or  so-called  artificial  Nauheim  baths,  may 
be  employed  in  cases  of  this  type.  At  the  outset  it  is  best  to  use 
salt  baths  containing  only  a  small  amount  of  carbon  dioxid. 
Permanent  lowering  of  arterial  pressure  has  been  noted  after 
this  method  of  treatment.     (See  p.  319.) 

The  associated  drinking  cures  at  Spas  are  highly  beneficial 
in  these  cases,  particularly  when  alkaline,  alkaline  calcic,  or 
magnesium  sulphate  waters  are  available  with  little  or  no  sodium 
chlorid  in  their  composition.  Sulphur  springs  are  useful  in 
many  cases,  the  water  being  applied  both  externally  and  in- 
ternally. Physicians  practising  at  sulphur  spas  claim  that  great 
benefit  is  derived  from  the  baths  through  their  stimulating  effect 
upon  the  glandular  system  and  upon  cellular  activity;  nutrition 
is  improved  and  perverted  metabolism  is  corrected.  The  stim- 
ulating effect  of  this  class  of  waters  upon  the  skin  also  tends,  to  a 
certain  degree,  to  improve  the  tone  of  the  circulation. 

In  cases  of  marked  arteriosclerosis,  baths  should  not  be 
given  except  with  the  utmost  care,  but  in  cases  of  high  tension 
without  arterial  change,  baths  always  do  good.  There  is  often 
a  high-tension  pulse  where  there  is  no  arteriosclerosis,  and  it  is 
rather  common  to  observe  patients  in  whom  there  is  a  high 
nervous  tension.  It  is  in  these  cases  that  the  full  warm  bath  for 
eight  or  ten  minutes,  followed  by  a  rain  bath  for  five  or  six  sec- 


CHRONIC   INTERSTITIAL   NEPHRITIS  115 

onds,  or  a  fan  douche,  will  prove  eminently  useful  by  allaying 
nervous  irritability.  These  are  the  neurasthenic  cases,  for  which 
treatment  is  outlined  on  pp.  162  and  163. 

Hot  Applications. — In  treating  chronic  nephritis,  hot  ap- 
pHcations  are  preferable  to  cold,  the  latter  producing  a  peripheral 
contraction  of  the  blood-vessels  before  the  ensuing  dilatation. 
A.  C  Croftan^  has  recently  called  attention  to  this  subject,  and 
claims  that,  in  predisposed  subjects,  the  primary  contraction 
may  rupture  weakened  vessels,  and,  by  increasing  the  heart's 
action,  thus  temporarily  increases  vascular  pressure.  In 
clironic  nephritis  the  reaction  may  fail  altogether,  owing  to  a 
lack  of  vascular  tone  or  changes  in  the  heart  muscles  or  those  of 
the  peripheral  arteries. 

For  reducing  vascular  pressure  hot  applications  are  more 
lasting  in  their  effect,  as  deeper  vessels  become  dilated.  Moist 
heat  is  best  unless  there  be  need  to  avoid  edema.  The  claim 
is  made  that  dry  heat  abstracts  so  much  water  from  the  blood 
that  the  toxins  become  concentrated.  This  is  a  theoretic 
objection  that  is  not  sustained  by  experience. 

Electric -light  Baths. — Pratt  treated  a  woman  with  chronic 
nephritis  who  had  been  ill  a  year.  She  had  marked  general 
anasarca  and  the  day  urine  contained  over  1  per  cent,  of  albumin. 
The  essential  features  of  the  treatment  instituted  were  electric- 
light  baths  and  a  salt-free  diet.  She  objected  strongly  to  the 
diet,  but  did  not  abandon  the  plan  of  treatment  because  she 
felt  that  the  light  baths  were  beneficial.  After  three  months 
the  edema  had  disappeared  except  for  a  slight  swelling  of  the  legs. 
When  last  seen,  three  years  later,  the  edema  had  not  recurred 
and  the  urine  contained  only  a  slight  trace  of  albumin.  It  is 
probable  that  her  recovery  was  due  more  to  the  salt-free  diet 
than  to  the  light  baths,  yet  without  them  she  never  would  have 
continued  with  the  diet. 

Dr.  Pratt  adds  that  in  nephritis  with  edema,  the  electric-light 
bath  furnishes  the  best  form  of  sweating  procedures.  The 
duration  should  not  be  more  than  thirty  minutes.     It  should 

1  Medical  Fortnightly,  March  23,  1906. 


116  HYDROTHERAPY 

be  followed  by  a  dry  blanket  pack  if  the  edema  is  marked  and 
the  patient  not  enfeebled.  A  hot  douche  may  end  the  treat- 
ment. 

It  is  well  to  use  short  Ught  baths  followed  by  mild  douches  in 
svbacute  and  chronic  nephritis  to  keep  the  sweat  glands  active 
and  to  aid  in  maintaining  the  normal  condition  of  the  heart  and 
circulation.  As  most  authorities  hold  that  cold  applications 
are  to  be  avoided  in  parenchymatous  nephritis,  one  may  su- 
stitute  for  them  a  salt  rub  followed  by  a  short,  hot  douche,  which 
has  a  stimulating  effect. 

Prescription. — Light  bath,  seven  to  twelve  minutes.     Salt  rub. 
Circular  douche  at  105°  F.  (40.4°  (".),  thirty  seconds,  15  pounds. 
Jet  and  fan  douche  at  105°  V.  (40.4°  ('.),  thirty  seconds,  15  pounds. 
Drj'  rub.     Rest  thirty  minutes. 
Repeat  three  times  weekly. 

Cold  Applications. — It  is  no  doubt  possible  to  apply  alto- 
gether too  energetic  procedures  in  nephritis  and  hence  produce 
harm.  For  this  reason,  cold  baths  and  douches  have  not  been 
used  by  the  author,  although  strongly  advocated  by  some  hydro- 
therapeutists,  von  Noorden  opposes  the  prejudice  against  cold 
water  and  strongly  advocates  the  cold  rub  (kalte  abreibung), 
followed  by  strong  friction  to  produce  reaction.  In  this  he  is 
supported  by  Dr.  Baruch. 

The  late  Dr.  G.  W.  Foster,  of  the  Eastern  Maine  Insane 
Hospital,  used  cold  applications  with  success  in  the  renal  com- 
plications of  acute  delirious  mania.  The  patients  had  a  marked 
reduction  in  the  amount  of  urine  and  of  urea  with  albumin  and 
casts.  He  applied  cold  wet  packs  over  the  loins  and  abdomen, 
and  also  general  cold  packs  and  full  baths  at  70°  F.  (21.1°  C). 
These  packs  were  applied  continuously  and  were  renewed  three 
or  four  times  daily.  Foster  held  that  renal  engorgement  of  the 
active  or  passive  type  does  not  contraindicate  the  use  of  tub-baths 
at  70°  F.  (21.1  °  C.)  if  they  are  not  unduly  prolonged.  His  general 
packs  were  given  with  water  at  70°  F.  (21.1  °  C.)  for  one  and  one- 
half  hours'  duration.  It  was  the  excellent  reaction  occurring  in 
the  pack  that  accomplished  the  result,  and  he  claimed  that  no 


UREMIA  117 

diuretic,  within  the  limits  of  his  eKperience,  was  at  once  so  effec- 
tual, safe,  and  generally  applicable  as  the  local  packs. 

Amount  of  Urine. — It  is  a  common  experience  to  note  an 
increased  amount  of  urine  after  various  hydrotherapeutic  meas- 
ures. This  is  more  evident  after  cold  apphcations  than  after 
warm  ones.  Cold  wet  packs  applied  over  the  loins  and  abdomen 
.or  tub-baths  at  70°  F.  (21.1°  C.)  or  below  wiU  almost  always 
increase  the  flow  of  urine.  This  may  amount  to  double  or  more 
than  triple  the  previous  amount  voided.  In  using  the  Brand 
bath  in  typhoid  fever  the  increase  of  urine  is  commonly  noted, 
and  much  of  the  benefit  derived  therefrom  is  due  to  the  increased 
elimination  of  toxic  matter  in  this  way.     (See  p.  45.) 

TOXEMIA  OF  PREGNANCY 

This  condition  is  liable  to  result  in  eclampsia  if  unrecognized 
and  untreated.  It  is  most  frequent  between  the  thirtieth  and 
thirty-fourth  weeks  of  pregnancy.  In  mild  cases  the  skin  should 
be  stimulated  by  simple  warm  baths,  given  in  connection  with 
enemata  and  lavage  by  normal  salt  solution. 

In  severer  cases  hot  packs  are  required  until  free  perspiration 
results.  As  the  urea  is  diminished,  batliing  and  the  internal  use 
of  abundant  pure  water  are  demanded. 

UREMIA 

In  uremic  cases  and  in  eclampsia  hot  packs  and  vapor  baths 
are  demanded.  One  should  not  postpone  venesection  in  order 
to  give  the  hot  pack.  The  hot  wet  pack  and  vapor  bath  are 
always  useful;  but  if  the  patient  be  unconscious,  great  care  must 
be  taken  to  see  that  the  skin  is  not  scalded.  Packs  may  be 
given  for  thirty  minutes  everj^  four  hours.  In  the  excitement 
attending  these  cases  accidents  have  happened  in  the  lying-in 
room. 

Hot  bricks  wrapped  in  flannel  soaked  in  hot  water  or  hot 
bottles  are  commonly  used  to  convey  moist  heat.  A  country 
practitioner  told  the  author  that  he  had  used  successfully  hot 
ears  of  corn.     Hot  corn  gives  off  a  great  deal  of  moisture  and 


118  HYDROTHERAPY 

retains  its  heat  for  a  long  time,  especially  when  some  of  the 
enveloping  husks  are  allowed  to  remain.  (See  p.  341.)  Under 
ordinary  circumstances  the  labor  may  be  let  alone  while  these 
measures  are  being  instituted. 

Baruch  has  observed  in  the  nephritis  of  severe  eclampsia 
a  decidedly  favorable  change  after  a  wet  pack  at  70°  F.  (21.1° 
C.)  for  one  hour.  (See  Teclmic,  p.  341.)  He  has  demonstrated 
to  his  clinical  students  that  after  such  a  cold  wet  pack  the  sheet 
is  taken  away  warmer;  wliile  after  a  hot  pack  the  blanket  is 
found  cool.  The  reason  is  simple:  the  reaction  during  a  cold 
pack  fills  the  cutaneous  vessels  with  warm  blood  and  thus  warms 
the  skin,  which  in  turn  warms  the  sheet;  while  the  hot  blanket 
or  sheet  gives  ofT  its  heat  to  the  skin,  thus  cooling  it.  The 
symptom  tension  is  relieved  by  the  latter,  and  excretion  is 
favored  or  rendered  more  normal  by  the  former. 

SCARLATINAL  NEPHRITIS 

Water  is  the  best  safeguard  in  this  disease.  Lime-water  or 
Vichy  should  be  added  to  the  milk  of  young  children,  and  aerated 
distilled  water,  Poland  Healing  Springs,  Celestin  Vichy,  Ballard- 
vale,  or  other  alkaline  water  should  be  administered  very  freely 
to  older  children  and  adults.  Freely  used,  it  dilutes  the  toxins 
and  diminishes  the  acidity,  thereby  lessening  kidney  irritation. 
By  stimulating  catharsis  and  diaphoresis  the  elimination  of 
toxins  is  faciUtated. 

For  treating  this  condition,  full  tub-baths  at  5  or  10  degrees 
below  the  body  temperature,  with  the  child  enveloped  in  a 
blanket,  give  the  best  results,  as  such  baths  provide  an  equal 
distribution  of  the  water.  For  infants  and  young  children  the 
bath  snould  be  warm— 100°  to  101°  F.  (37.8°-43.3°  C.).^ 

DIABETES  MELLITUS 

The  well-known  tendency  of  this  disease  toward  infections 
of  the  skin  and  even  to  such  serious  complications  as  gangrene 

1  See  article  by  Lowenburg,  Jour.  Amer.  Med.  Assoc,  Feb.  17,  1906;  see 
also  p.  80. 


DIABETES   MELLITUS  119 

renders  it  highly  important  to  preserve  the  cleanliness  and  in- 
tegrity of  the  skin.  Aside  from  the  usual  daily  cleansing  bath 
of  warm  water  with  soap,  it  is  desirable  to  educate  the  patient  to 
the  use  of  cold-water  sponges,  plunge  baths,  and  douches,  so  as 
to  increase  the  tone  of  the  skin  and  of  the  nervous  system,  and, 
at  the  same  time,  to  improve  the  general  and,  especially,  the 
peripheral  circulation.  In  advanced  cases  the  best  plan  is  to 
institute  these  measures  at  home  and  not  to  advise  distant  spas. 
The  continuous  or  hammock  bath  at  95°  F.  (35°  C.)  for  half  an 
hour  or  longer,  repeated  twice  a  day,  is  advised  in  case  the  skin 
shows  any  serious  feature.  Hydrotherapy  is  an  aid  to  dietetic 
management. 

The  following  prescription  may  be  given  in  moderate  cases: 

Electric-light  bath,  five  to  ten  minutes. 
Circular  douche,  105°  F.  (40.5°  C),  thirty  seconds. 
Circular  douche,  90°  F.  (32.2°  C),  thirty  seconds. 

Jet  and  fan  douche  to  entire  body  at  70°  F.  (21.1°  C),  twenty  seconds. 

Repeat  daily,  gradually  increasing  pressure  of  jet  douche  and  lowering 

terminal  temperature  until  20  pounds  and  60°  F.  (15.5°  C.)  are  reached. 

In  the  case  of  patients  in  which  the  disease  is  not  far  advanced, 

the  beneficial  effects  of  mountain  spas  at  moderate  altitude  and 
conveniently  reached  are  well  recognized. 

Drinking  Cure. — While  baths  are  not  curative  in  diabetes, 
some  features  of  the  disease  are  modified  by  hydrotherapy, 
especially  when  waters  are  also  used  internally.  At  most  spas 
this  is  the  case,  and  the  accessories  of  agreeable  surroundings, 
different  air,  food,  and  occupation  improve  wonderfully  the 
morale  of  diabetics  and  work  a  corresponding  improvement  in 
their  physical  states.  At  Carlsbad,  Marienbad,  Ems,  Royat, 
Vichy,  Neuenahr,  and  Mont-Dore  diabetic  patients  are  treated 
with  more  or  less  success  by  the  combined  method.  These 
thermal  waters  favorably  affect  the  skin,  which  is  frequently 
very  dry,  and  for  the  obese  cases  warm  baths  are  a  distinct  ad- 
vantage. Baths  in  the  iron  waters  of  Schwalbach,  Spa,  Pyrmont, 
and  Franzensbad,  and  ferruginous  peat-baths  are  commonly  used 
abroad,  but,  as  it  has  elsewhere  been  shown,  these  waters  have 


120  HYDROTHERAPY 

no  special  virtues  by  reason  of  their  iron  content.  Their  use  in- 
ternally, as  is  also  the  case  with  alkaline  carbonated  waters,  is  of 
considerable  value.  Conscc|uently,  the  drinking  cure  is  the  more 
important. 

Sea-bathing  is  permissible  when  the  patient  is  robust  and 
reacts  well  and  when  anemia  is  not  marked.  It  is  not  strongly 
indicated  in  obese  cases. 

The  Turkish  bath  is  contraindicated. 

DIABETES  INSIPIDUS 

In  diabetes  insipidus,  douches,  warm  or  cold  baths,  packs,  and 
half-baths  are  advised.  Forchheimer  recommends  the  half-bath 
in  all  nervous  children  having  diabetes  insipidus.  Baruch  advises 
neurovascular  training,  as  in  neurasthenia. 

As  in  diabetes  mellitus,  Turkish  baths  are  contraindicated. 

PHOSPHATURIA 

This  is  commonly  met  with  in  eases  of  neurasthenia  and  is 
usually  relieved  or  cured  by  the  hydrotherapeutic  methods  em- 
ployed in  that  affection.  Among  these  are  the  half-bath  with 
friction  and  affusions,  rain  baths  or  the  descending  douche,  cold 
wet  packs,  and  steam  or  electric-light  baths,  followed  by  circular 
and  jet  douches.  Sea-bathing  and  the  attendant  exercises  avail- 
able at  seaside  resorts  are  very  beneficial  in  phosphaturia.  Ex- 
ercise favors  the  return  of  the  natural  acid  to  the  stomach  and 
secretions.  Mountain  spas  are  well  suited  for  such  cases.  (See 
p.  162.) 

RHEUMATISM 

CHRONIC  RHEUMATISM 

Chronic  rheumatism  is  essentially  a  fibrositis  or  an  inflam- 
matory hyperplasia  of  the  fibrous  tissue  of  the  muscles,  joints, 
and  ligaments.  It  is  brought  about  by  exposure  to  cold,  damp 
and  wet  weather,  sudden  changes  of  temperature  from  hot  to 
cold;  or  an  attack  may  date  from  predisposing  causes,  such  as 
injuries  to  limbs.    An  acute  traumatic  arthritis  may  eventually 


CHRONIC   RHEUMATISM  121 

become  a  "rheumatic"  joint.  Irritating  toxins  from  the  in- 
testinal tract  or  from  an  acute  gonorrhea  may  result  in  a. so-called 
general  acute  articular  rheumatism  due  to  their  specific  poisons. 

The  value  of  thermal  springs  in  the  treatment  of  chronic 
articular  rheumatism  and  the  arthrites  is  recognized  the  world 
over.  The  chief  factors  are  the  systematic  application  of  heat, 
the  manipulation  practised  in  the  baths,  and  the  consequent 
improvement  of  the  circulation  in  the  parts  affected. 

The  patient  for  whom  such  treatment  is  deemed  suitable  is 
placed  in  a  fuU  bath  at  102°  to  104°  F.  (38.9°-40°  C),  with  his 
head  wrapped  in  a  turban  wet  in  cold  water.  An  attendant 
rubs  the  limbs  and  the  body  while  the  patient  is  in  the  bath, 
applying  movements  graded  in  force  to  the  affected  joints.  In 
patients  accustomed  to  hot  bathing,  it  is  possible  to  begin  with 
a  temperature  of  104°  F.  (40°  C),  which,  in  most  cases,  is  quite 
agreeable.  After  eight  or  ten  minutes  of  the  full  bath  the  patient 
is  dried  and  laid  on  a  couch,  where  he  is  closely  packed  in  a  hot 
dry  sheet  and  enclosed  in  three  or  four  blankets.  Here  he  re- 
mains for  eight,  ten,  or  twelve  minutes,  after  which  he  is  rubbed 
vigorously  for  five  minutes  with  alcohol.  On  the  fourth  day  the 
bath  may  be  omitted  and  afterward  the  baths  may  include  a  pre- 
liminary hot  douche  at  103°  or  104°  F.  (39.3°  or  40°  C),  applied 
all  over  the  body  excepting  the  head,  the  anterior  chest,  and  the 
abdomen.  The  elements  of  this  bath  are  naturally  adjusted 
in  time  and  in  force  to  the  needs  of  the  patient  as  may  be  de- 
termined by  his  medical  adviser.  Cool  sponging  or  a  cold 
douche  is  frequently  employed  after  the  pack.  General  mas- 
sage is  also  employed  in  suitable  cases,  sometimes  during  the 
day,  but  not  usually  directly  after  the  bath,  as  after  the  bath  the 
patient  should  rest  quietly  for  an  hour. 

The  rationale  of  this  method  lies  in  the  better  circulation  estab- 
lished around  the  joints  and  in  the  increased  mobility  of  all  the 
tissues  involved.  Exudates  in  the  fibrous  investments  of  joints, 
in  the  sheaths  of  tendons,  and  in  the  muscular  tissue  create  more 
or  less  disability,  and,  if  untreated  by  external  agencies,  tend  to 
increase  pain  and  stiffness  if  not  toward  fixation  of  the  limb.     In 


122  HYDROTHERAPY 

the  case  of  spinal  arthritis,  even  more  serious  fixation  and  deform- 
ity are  likely  to  ensue,  and  hence  the  usefulness  of  general  physi- 
ologic measures  like  hydrotherapy  and  massage. 

In  a  systematic  course  of  bathing  the  secret  of  success  lies  in  a 
judicious  education  of  the  patient  to  bear  heat  and  manipulation 
in  an  increasing  gradation.  Mild  measures  at  the  outset  induce 
confidence  and  make  possible  later  a  degree  of  manipulation, 
depending  upon  the  special  characteristics  of  the  case  in  hand, 
that  would  not  otherwise  be  secured. 

After  a  full  bath  in  warm  or  moderately  hot  water,  e.  g.,  at 
104°  F.  (40°  C),  followed  by  a  hot  dry  pack,  there  is  relaxation 
with  sweating.  A  subsequent  alcohol  rub  is  then  refreshing  and 
produces  a  tonic  effect.  This  is  the  main  feature  of  the  treat- 
ment at  the  Virginia  Hot  Springs. 

It  is  well-known  that  when  limbs  are  immersed  in  water 
less  pain  is  elicited  on  active  or  passive  movements  than  when 
the  same  movements  are  practised  in  the  usual  atmospheric 
medium.  This  fact  is  taken  advantage  of  in  these  cases  to  the 
fullest  extent,  constituting  one  of  the  advantages  of  the  full 
bath.  In  the  bath  the  action  of  the  skin  is  made  better  by  the 
friction,  which  should  always  be  insisted  on,  it  becoming  more 
pliable  and  free  from  all  excretory  matter.  Both  the  super- 
ficial and  the  deep  blood-vessels  of  the  part,  too,  are  enabled 
to  take  up  and  carry  off  any  exudates  or  infiltrates,  and  thus 
relieve  the  restrictive  influences  on  the  motion  of  the  struc- 
tures involved,  and  the  impairment  of  a  proper  interchange  of 
circulation.  Therefore,  we  adopt  every  means  calculated  to 
improve  nutrition. 

Secondary  muscular  atrophy,  which  is  commonly  observed 
in  chronic  joint  disease,  may  be  forestalled  if  treatment  be  started 
early  and  massage  judiciously  used  in  connection  with  hydro- 
therapy. 

Painful  Reaction. — After  three  or  four  baths  there  is  usually 
a  febrile  painful  reaction  in  the  affected  parts.  This  return 
of  tenderness  and  swelling  is  discouraging  to  the  patient.  He 
should  be  warned  in  advance  of  it,  and  should  be  comforted 


ACUTE   RHEUMATISM  123 

by  the  thought  that  it  is  a  favorable  indication  of  the  ultimate 
relief  to  be  derived  from  the  methods  employed. 

Tlie  Uric -acid  Fetich. — ^This  still  lingers  with  us  and  will 
probably  remain  for  many  years  a  valuable  asset  of  many  a 
mineral  spring  and  patent  medicine  factory.  As  Dr.  Arthur  P. 
Luff  of  England  says :  "It  has  become  of  late  years  a  fashionable 
craze  to  attribute  many  of  these  forms  of  '  chronic  rheumatism ' 
to  uric  acid.  Most  emphatically  do  I  declare  that  it  has  neither 
part  nor  parcel  in  the  production  of  any  of  these  forms  of  fibrositis. 
I  believe  that  uric  acid  possesses  no  toxic  properties  whatever, 
and  I  take  this  opportunity  of  most  earnestly  raising  my  voice 
against  the  absurd  modern  fetichism  of  this  nitrogenous  by- 
product, and  of  protesting  against  the  shameful  exploitation  of 
it  as  a  dangerous  poison  which  too  frequently  disgraces  the 
advertisement   columns   of   our   daily,    weekly,   and    monthly 

papers." 

ACUTE  RHEUMATISM 

In  acute  rheumatism,  douches,  affusions,  and  local  and  full 
baths  may  be  employed  if  the  patient  be  not  wholly  disabled. 
Most  cases  of  acute  rheumatism,  however,  are  made  worse  by 
motion,  so  that  it  is  usually  a  case  of  noli  me  tangere.  If  cold 
water  in  any  form  be  used,  however,  it  should  be  accompanied 
by  vigorous  friction.  The  body  may  first  be  sponged  with  water 
at  104°  to  108°  F.  (40°-42.2°  C.)  for  three  minutes,  followed 
with  a  vigorous  rubbing  with  cold  water  at  70°  to  60°  F.  (21.1°- 
15.6°  C.)  (Cohen). 

The  intense  pain  on  motion,  the  fever,  and  the  high  pulse- 
rate  generally  observed  constitute  counterindications  for  tub- 
baths.  If  the  pulse-rate  in  the  recumbent  position  be  above 
90,  the  patient  should  not  leave  his  bed.  When  the  pulse  is 
lowered  to  80,  tub-baths  may  be  instituted.  It  is  best  in  cases 
in  which  the  heart  is  affected  to  begin  with  a  half-bath  at  a  tem- 
perature of  98°  F.  (36.7°  C.)  two  or  three  times  a  week,  and  then 
increase  their  frequency  as  may  be  indicated.  Cardiac  com- 
plications render  the  use  of  greater  heat  than  98°  F.  (36.7°  C.) 
unsafe. 


124  HYDROTHERAPY 

CEREBRAL  FORM  OF  RHEUMATISM 

Cold  Baths. — In  the  hyperpyrexia  of  acute  rheumatism,  in 
cases  of  the  cerebral  type,  where  the  temperature  suddenly 
rises  from  102°  or  103°  F.  (38.9°  or  39.4°  C.)  to  105°  F.  (40.6°  C), 
cold  baths  should  be  employed  at  once.  The  water  having 
an  initial  temperature  of  85°  to  90°  F.  (29.4°-32.2°  C.)  is 
gradually  lowered  to  65°  or  60°  F.  (18.3°  or  15.6°  C).  If  the 
patient  be  unconscious,  he  should  be  placed  in  water  at  65°  F. 
(18.3°  C.)  without  delay,  the  duration  of  the  bath  being  governed 
by  the  fall  of  temperature  to  101°  or  100°  F.  (38.3°  or  37.8°  C). 
It  will  probably  fall  from  1  to  3  degrees  more  after  removal  from 
the  bath.  In  the  first  bath  a  longer  time  is  usually  required  to 
effect  the  same  amount  of  temperature  reduction  than  in  sub- 
sequent baths — perhaps  a  half-hour  or  more.  When  removed 
from  the  bath  the  patient  is  dried  and  some  stimulant  given. 
If  necessary,  the  baths  may  be  repeated,  but  sometimes  one 
will  suffice. 

The  cerebral  form  of  rheumatism  is  so  serious  in  itself  that 
there  are  practically  no  counterindications.  The  Clinical  Society 
of  London,  through  a  Committee,  has  reported  that  only  1  case  re- 
covered among  those  observed  having  a  temperature  higher 
than  106°  F.  (41.1°  C.)  in  which  the  bath  was  not  employed; 
while  of  the  batherl  cases  with  a  temperature  of  over  106°  F. 
(41.1°  C.)  nearly  60  per  cent,  recovered.  Several  cases  are  on 
record  in  which  the  temperature  reached  110°  F.  (43.4°  C.) 
and  in  which  recovery  has  followed  the  use  of  the  bath;  in  some 
cases  twenty-six  baths  have  been  employed.^ 

These  baths  not  only  reduce  the  temperature,  but  they 
quiet  the  delirium;  if  comatose,  the  mind  becomes  clear,  the 
pulse  is  reduced  in  frequency,  and  normal  sleep  returns  to 
relieve  the  nervous  system.  When  baths  for  any  reason  cannot 
be  used,  the  patient  should  be  sponged  with  ice-cold  water  or 
the  cold  wet  sheet  pack  should  be  employed;  or  he  should  be 

1  See  James  Stewart,  American  Text-book  of  Applied  Tlierapeutics,  p.  535, 
W.  B.  Saunders  Company. 


CEREBRAL   FORM   OF   RHEUMATISM  125 

placed  on  a  cot  protected  with  rubber  and  douched  with  water 
from  a  large  sponge. 

Cabinet  Baths  and  Douches. — Although  the  method  pre- 
viously described  ^  is  the  one  usually  adopted  by  the  author, 
another  method  may  be  chosen  and  will  give  excellent  results. 
Patients  who  have  had  the  baths  and  packs  for  a  time  may  be 
given  a  short  series  of  cabinet  baths  and  douches.  The  pre- 
scription would  read  as  follows : 

Hot-air  bath  or  electric-light  bath  at  150°  to  160°  F.  (65.6°- 
71.1°  C),  ten  to  twenty  minutes. 

Circular  douche  at  90°  F.  (32.2°  C),  one  minute,  20  pounds. 

Scotch  douche  at  110°  F.  (43.4°  C.)  and  60°  F.  (15.6°  C), 
twenty  seconds,  20  pounds. 

Massage  for  the  affected  joints  and  muscles,  fifteen  minutes. 

It  may  be  desirable  to  start  treatment  with  less  contrast 
between  the  maximum  and  minimum  of  the  Scotch  douche,  and 
in  the  course  of  four  or  five  baths  reach  the  temperature  in- 
dicated in  the  prescription.  If  a  greater  contrast  be  desired, 
live  steam  may  be  employed  in  the  Scotch  douche.  A  rapid 
alternation  of  steam  and  cold  water  produces  a  profound  local 
effect,  and  when  the  variation  in  temperature  is  so  great,  as  in  this 
case,  the  Scotch  douche  can  be  shortened  to  ten  or  fifteen 
seconds.  The  douche  apparatus  ordinarily  in  use  is  not  pro- 
vided with  means  for  employing  steam,  but  this  forms  a  valu- 
able accessory.  The  Scotch  douche  exerts  a  strong  mechanical 
and  thermal  stimulus,  and  promotes  the  absorption  of  exudates 
in  and  about  the  joints  and  muscles.  A  combination  of  douches 
of  two  different  pressures  with  simultaneous  massage,  as  prac- 
tised at  Aixles-Bains,  is  very  useful.  So  also  the  fixed  douche, 
delivering  water  at  102°  to  104°  F.  (39.9°-40°  C.)  for  eight 
or  ten  minutes  at  15  to  18  pounds'  pressure,  may  be  made  use  of 
preliminary  to  the  full  bath  and  pack. 

Fomentations  are  useful  in  muscular  rheumatism.  The 
affected  parts  are  well  lubricated  with  petroleum  so  as  to  re- 
duce the  danger  of  scalding  the  patient,  and  compresses,  well 

1  See  p.  121. 


126  HYDROTHERAPY 

wrung  out  of  hot  water  at  about  140°  to  150°  F.  (60°-65.6°C.), 
should  be  applied.  Compresses  lose  heat  so  quickly  that  the 
actual  temperature  of  application  is  much  less,  and  by  making 
cautious  attempts  to  place  them,  a  fairly  high  degree  of  heat 
can  be  borne.  After  the  fomentations  have  been  applied  and 
reapplied  for  ten,  fifteen,  or  twenty  minutes,  the  patient  is 
washed  off  with  water  at  70°  F.  (21.1°  C),  with  friction,  and 
dried.  The  addition  of  magnesium  sulphate  will  enhance  the 
value  of  the  compresses  (see  p.  220).  After  this  treatment 
the  patient  should  rest  for  an  hour  on  a  bed  or  lounge. 

PROPHYLAXIS  OF  RHEUMATISM 

Hydrotherapy  has  a  place  in  the  prevention  of  rheumatism. 
In  the  case  of  children  believed  to  be  rheumatically  predisposed 
it  would  be  proper  to  adopt  a  careful  and  systematic  method 
of  accustoming  the  child  to  cool  water.  Cool  salt-water  baths 
followed  by  vigorous  friction  are  of  value  in  this  respect,  in  that 
they  improve  the  resistance  and  reaction  of  the  vasomotor  sys- 
tem. These  baths  can  be  cultivated  as  any  other  physical 
power.  Vasomotor  paralysis,  with  its  tendency  to  the  forma- 
tion of  toxins,  should  be  met  with  appropriate  exercises,  cool 
baths,  and  frictions;  electric-light  baths  and  general  thermic 
stimulation.  Sea-bathing  is  usually  attended  with  too  much 
exposure  and  risk  for  children  predisposed  to  rheumatism. 

RHEUMATIC  ENDOCARDITIS 
In  cases  complicated  with  endocarditis,  with  a  weak  heart 
and  a  feeble,  irregular  pulse,  hot  fomentations  should  be  employed 
locally  over  the  heart.  They  will  be  found  more  stimulating 
than  ice-bags  or  cold  compresses.  (See  chapter  on  Diseases  of 
the  Heart,  p.  132.) 

ACUTE  ARTHRITIC  OUTBREAKS 

The  acute  arthritic  outbreaks  which  so  often  follow  spa  treat- 
ment depend  upon  the  thermal  action  of  the  mineral  baths. 
Similar  attacks  follow  the  use  of  plain  hot-water  baths  devoid 


GOUT  (arthritis  urica)  127 

of  mineral  properties.  Garrod  has  seen  a  severe  attack  of  gout 
brought  on  by  taking  a  hot  bath  soon  after  dinner.  Hot-air 
baths  in  cases  of  suppressed  gout  may  determine  an  acute  attack. 
These  acute  phenomena  are  usually  interpreted  as  preparing 
the  way  for  the  elimination  of  uratic  deposits.  Though  painful, 
the  ultimate  result  is  beneficial ;  the  absence  of  any  reaction  in 
a  case  of  gout  after  the  adoption  of  thermal  baths  does  not 
augur  well  for  the  benefits  to  be  derived  from  the  treatment.^ 
Warnings  should  be  given  the  patient  of  the  likehhood  of  acute 
symptoms  supervening. 

Dr.  H.  C.  Wood  says  that  he  has  frequently  seen  an  acute 
attack  of  gout  precipitated  by  the  application  of  heat  to  a  long 
diseased  joint  about  which  there  was  much  exudation.  This 
acute  attack  has  often  been  accompanied  by  a  very  percep- 
tible lessening  of  the  exudate,  and  Dr.  Wood  states  his  belief 
that  such  attacks  are  due  to  the  absorption  into  the  blood  of 
gouty  acids  or  salts  which  had  been  liberated  from  tissues  of 
the  joint.  Undoubtedly  the  chemic  movements  of  diseased 
joints  or  exudates  in  other  localities  are  increased  by  the  appli- 
cation of  heat.  The  use  of  heat  is  of  great  value  in  the  treat- 
ment of  local  inflammatory  conditions  with  exudation,  whether 
rheumatic  or  not.     In  these  cases  fomentations  may  afford  relief. 

GOUT   (ARTHRITIS  URICA) 

In  all  probability  gout  consists  in  a  defect  of  metabolism 
whereby  products  derived  from  cell  nuclei  are  not  properly  used 
up  or  excreted.  These  products  may  arise  either  from  nuclear 
matter  contained  in  the  food  or  from  the  natural  wear  and  tear 
of  tissue-nuclei;  they  are  retained  in  the  system,  and  a  deposit 
of  one  of  them — sodium  biurate — in  the  joints  sets  up  irritation 
there  and  causes  an  acute  attack  of  arthritis. 

We  must  not  be  blind  to  the  fact  that  in  using  "that  blessed 
word"  metabolism,  we  mean  no  more  than  the  chemical  side  of 
life  itself.    All  diseases  are  disorders  of  metabolism — in  other 

1  Francis  Hare,  M.  D.,  Medical  Record,  June  17,  1905. 


128  HYDROTHERAPY 

words,  perverted  vital  activity.  Hence  we  practically  come 
back  to  our  original  starting  point — that  gout  is  a  disease  which 
we  do  not  understand.' 

The  hydrotherapy  of  gout  follows  very  much  the  same  lines  as 
that  of  rheumatism.  It  is  a  protean  disease  capable  of  mani- 
festations from  the  head  to  the  toe,  and,  in  its  acute  stages, 
a  formidable  afTection. 

Gouty  affections  respond  favorably  to  hydrotherapeutic 
and  dietetic  treatment;  indeed,  patients  of  this  class  constitute 
a  very  large  proportion  of  the  clientele  of  spas.  Such  patients, 
perhaps  more  than  any  other,  recognize  the  importance  of  re- 
peated preventive  measures  and  frequently  make  a  practice  of 
taking  the  cure  afTortled  at  famous  resorts  in  Europe  and  America. 

Choice  of  Spas. — An  attempt  has  been  made  to  differentiate 
the  various  European  spas  in  the  treatment  of  gout,  largely  on 
the  basis  of  the  associated  use  of  waters  internally^  (see  pp.  404 
and  410). 

The  methods  employed  vary  considerably  at  these  spas  and 
the  waters  themselves  vary  widely  in  their  constituents,  embrac- 
ing those  of  indifferent  character,  such  as  Teplitz,  Warmbrunn, 
and  Plombieres;  the  sulphur  waters  of  Aix-la-Chapelle,  Baden  in 
Austria,  Baden  in  Switzerland,  Bareges,  and  Cauterets;  or  the 
brines  of  Nauheim,  Kissingen,  and  Soden.  In  general,  the 
distinction  is  made  that  when  local  effusions  remain  after  re- 
peated attacks  of  gout,  thermal  baths  of  high  temperature  are 
indicated.  These  are  employed  for  all  local  gouty  affections  as 
as  well  for  their  paralytic  and  neuralgic  sequelae. 

In  cases  of  great  debility  the  baths  given  at  Gastein,  Pfaefers- 
Ragatz,  Wildbad,  and  Lobche-les-bains  are  suitable.  When 
there  are  large  gouty  nodules,  contractures,  anchyloses,  and  dis- 
orders due  to  effusions,  local  and  general  peat  and  mud-baths 
are  used. 

The  sulphur  waters  are  chosen  when  skin  affections  or  syph- 

1  Editorial,  Medical  News,  July  23,  1903. 

2  See  Prof.  E.  Heinrich  Kisch,  of  Prague  and  Marienbad,  in  A  System  of 
Physiologic  Therapeutics,  vol.  ix,  p.  464. 


GOUT  (arthritis  urica)  129 

ilitic  diseases  coexist.  When  the  heart  is  impaired  and  general 
enfeeblement  marks  the  case,  the  sahne  baths  and  carbonated 
baths  of  Nauheim,  Rehne,  Kissingen,  and  Soden  are  prescribed. 

In  England  the  baths  of  Buxton  are  largely  used  for  gout. 
The  Buxton  undercurrent  or  indirect  douche  described  on  p.  277 
affords  an  excellent  combination  of  a  partial  immersion  warm 
bath  with  a  douche  of  somewhat  higher  temperature,  98°  to 
104°  F.  (36.7-40°  C),  and  a  moderate  pressure  of  15  pounds  to 
the  square  inch  from  a  small-caliber  nozzle.  The  famous  Aix 
douche,  comprising  two  calibers  and  two  pressures  administered 
by  two  attendants,  is  used  without  the  immersion  bath,  but  ac- 
companied by  general  and  local  massage  (see  p.  263). 

At  the  Virginia  Hot  Springs  use  is  made  of  a  fixed  descend- 
ing jet  douche  delivering  water  at  104°  F.  (40°  C.)  at  a  pressure 
of  14  to  18  pounds.  This  is  commonly  followed  by  a  full  bath 
at  100°  to  104°  F.  (37.8°-40°  C),  with  or  without  massage  in 
the  tub,  and  a  subsequent  dry  blanket  pack  for  ten  to  twenty 
minutes,  terminating  with  a  cool  douche  and  a  quick  alcohol  rub. 

At  Mt.  Clemens,  Michigan,  and  at  Richfield  Springs,  Sharon 
and  Clifton  Springs,  New  York,  sulphur  baths  and  douches  are 
employed.  These  sulphureted  saline  waters  are  usually  em- 
ployed at  somewhat  lower  temperatures  than  at  the  Virginia 
Hot  Springs,  and,  the  waters  being  of  a  naturally  lower  tempera- 
ture, are  necessarily  artificially  heated  to  the  required  degree. 

There  is  scarcely  a  spring  or  inland  spa  in  Europe  or  America 
where  the  treatment  of  gout  and  rheumatism  by  hydrothera- 
peutic  measures  may  not  be  carried  out.  If  the  pubHcations 
emanating  from  these  resorts,  usually  accompanied  by  a  wealth 
of  testimony  as  to  cures  in  this  class  of  diseases,  are  to  be  believed, 
it  must  be  admitted  that  gout  and  rheumatism  are  cured  by 
baths  in  waters  of  most  diverse  chemic  analysis;  by  baths  of 
every  type;  by  douches,  packs,  mud,  peat,  and  fango,  not  to 
speak  of  drinking-waters  of  every  description. 

This  leads  us  to  deny  any  essential  difference  in  hydrotherapy 
as  distinguished  from  balneology;  they  are  but  parts  of  one  great 
system  of  physical  therapy.     The  attempt  to  differentiate  the 


130  HYDROTHERAPY 

relative  value  of  various  mineral  waters  or  even  of  various  hydro- 
therapeutic  methods  in  relation  to  the  protean  forms  of  gout  and 
rheumatism  is  a  relic  of  the  time-honored  search  for  specific 
remedies  in  given  forms  of  disease.  The  modern  medical  world 
is  gradually  giving  up  this  jmrsuit  of  the  golden  fleece  in  thera- 
peutics and  is  turning  to  the  more  rational  effort  to  make  use  of 
general  measures  based  on  physiologic  processes,  relegating  to  the 
background  the  non-essential  features  once  so  highly  prized. 

The  prime  factors  in  all  modern  hydrotherapy  are  moisture, 
heat,  pressure,  and  manipulation.  These  are  the  four  corners  of 
the  temple  of  hydrotherapy. 

GONORRHEAL  ARTHRITIS 

Gonorrheal  rheumatism,  so  called,  or  gonorrheal  arthritis 
may  be  treated  in  the  same  manner  as  other  forms  of  rheumatism 
or  arthritis;  namely,  by  warm  or  hot  baths,  douches  of  warm  or 
hot  water,  not  over  104°  F.  (40°  C),  and  the  subsequent  use  of 
hot  dry  packs.  At  Buxton  the  practice  is  to  use  the  undercurrent 
douche  to  the  affected  joints.  If  synovitis  be  present,  the  joints 
are  kept  at  rest.  Plenty  of  good  nourishing  food  and  iron  are 
used.  Under  this  method  of  treatment  the  periosteal  thickenings 
quickly  disappear.^     (See  p.  277.) 

The  object  of  treatment  is  to  promote  absorption  of  inflam- 
matory products.  These  are  found  in  the  synovial  sheaths, 
bursse,  and  tendons.  They  need  the  stimulation  of  heat  and 
moisture,  but  do  not  require  much,  if  any,  manipulation,  unless 
in  the  more  advanced  or  chronic  stage.  Fomentations  may 
greatly  relieve  the  pains  of  the  more  acute  cases. 

In  dealing  with  advanced  cases  we  may  use  more  stimulus  in 
the  form  of  jets  of  higher  pressure,  the  Scotch  douche  with  its 
variations  of  temperature  and  the  Aix  douche,  or  other  revulsive 
measures.  In  any  case  care  must  be  exercised  to  avoid  bringing 
on  active  inflammation  by  vigorous  attempts  at  passive  motion 
or  by  too  severe  massage. 

^  Personal  communication  from  Dr.  John  Braithwaite,  Buxton. 


ARTHRITIS   DEFORMANS  131 

In  the  later  stages  of  gonorrheal  arthritis,  benefit  may  be 
derived  from  very  hot  mud-baths.  The  general  plan  of  treat- 
ing gonorrheal  arthritis  is  similar  to  that  of  ordinary  articular 
rheumatism,  at  least  as  far  as  hydrotherapy  is  concerned;  but 
the  writer  has  found  the  endocarditis  of  gonorrheal  cases  a  serious 
complication  and  one  that  demands  watching  and  very  judicious 
management. 

ARTHRITIS  DEFORMANS 

This  is  probably  an  infectious  trophoneurosis. 

In  order  to  bring  about  absorption  of  the  exudates  and 
restore  motion  to  the  affected  joints,  it  is  a  common  practice  in 
Europe  to  employ  hot-air  baths,  compresses  of  fango,  moor 
baths  or  packs,  hot  wet  packs,  hot-sand  baths,  or  electric-light 
baths.  After  these  applications  there  is  an  increased  sweat  pro- 
duction followed  by  a  moderation  of  the  symptoms,  together  with 
reduction  of  the  swelling  and  increased  mobility  of  the  joints. 
When  the  disease  has  progressed  so  far  as  to  have  produced  hyper- 
plasia with  deformity,  the  prognosis  is  unfavorable,  no  matter 
what  means  are  employed.  Amelioration  may  follow  hydrother- 
apy, though  cure  may  be  impossible.  Hot  sulphur  saline  baths 
have  given  some  good  results. 

Most  observers  agree  that  ordinary  hot  baths  in  arthritis 
deformans  are  not  to  be  recommended  or,  at  least,  are  to  be  em- 
ployed only  in  the  early  stages.  When  ordinary  baths  are  not 
employed  it  is  better  to  use  the  Bier  passive  congestion  treat- 
ment (compression  by  rubber  bandage  above  the  joint)  or  baking 
with  hot  dry  sand  or  hot  air.  The  writer  uses  the  hot-air  cabinet 
followed  by  circular,  jet,  Scotch,  and  fan  douche.  The  type  of 
bath  employed  must  be  determined  after  study  of  the  individual 
case.    After  the  bath  the  patient  should  walk  in  the  open  air. 

Dr.  Wood  states  that  the  effects  of  heat  are  much  more  prompt 
and  marked  in  cases  of  small  than  of  large  joints.  The  latter  are 
not  raised  to  that  degree  of  heat  possible  with  smaller  joints,  and 
for  this  reason  better  results  are  obtained  in  treating  an  ankle 
than  a  knee. 


132  HYDROTHERAPY 

The  use  of  heat  in  rheumatic  cases  should  not  be  relied  upon 
exclusively,  but  rather  as  an  aid  to  general  treatment.  When  so 
used,  the  action  of  the  skin  mut^t  be  increased  by  warm  douches 
and  tub-baths  (see  p.  121)  and  the  patient  well  wrapped  in 
blankets. 

DISEASES  OF  THE  HEART 

No  hydrotherapeutic  measure  of  a  general  character  for 
medical  purposes  should  be  used  without  competent  advice. 
This  presupposes  some  knowledge  of  the  heart  and  circulation 
and  ought  to  include  some  estimation  of  the  blood-pressure. 
It  is  remarkable  how  man}'  persons  are  perfectly  willing,  and  some- 
times quite  insistent,  in  their  desire  to  take  hot  baths,  douches, 
and  packs  without  any  competent  medical  advice,  relying  entirely 
on  the  bathing  attendant  or  previous  experience.  Anyone  who 
has  practised  at  a  spa  is  familiar  with  this  type.  Men  who 
would  not  for  a  moment  think  of  managing  their  owti  legal  affairs, 
will  not  hesitate  to  subject  their  bodies  to  all  sorts  of  circulatory 
gymnastics.  Whether  the  results  are  good,  bad,  or  indifferent  is 
probably  their  own  affair,  but  it  is  the  duty  of  those  in  charge 
of  spas  to  insist  on  preliminary  medical  advice.  There  is  prob- 
ably no  public  resort  in  the  United  States  where  this  is  strictly 
required.  Those  under  private  management  endeavor  to  give 
treatment  only  on  a  physician's  prescription,  and  this  undoubtedly 
furnishes  some  safeguard  against  much  disappointment  or  serious 
accident.  Sudden  death  in  the  bath  or  within  a  few  hours  after- 
ward is  occasionally  reported  in  the  daily  press  and  may  happen 
at  the  best  regulated  spas.  Deaths  from  heart  disease  and  apo- 
plexy are  most  to  be  feared  and  cannot  always  be  foreseen.  The 
class  of  patients  coming  to  mineral  spas  includes  those  who  have 
persistently  overworked  their  brains,  overfilled  their  stomachs, 
overstimulated  their  hearts,  and  indulged  in  all  sorts  of  excesses, 
so  that  the  problem  of  restoring  them  to  normal  condition  is 
one  of  the  greatest  in  medicine.  Many  recognize  the  value  of 
hydrotherapy  and  return  to  their  favorite  spas  once  or  twice  a 


DISEASES    OF    THE    HEART  133 

year  ''to  take  the  cure,"  and  thus  Uve  on,  more  or  less  restored 
for  future  work  or  indulgences  as  the  case  may  be. 

The  most  famous, spa  in  the  world  for  cardiac  affections  is, 
undoubtedly,  Nauheim.  Its  popularity  is  evidenced  by  the  fact 
that  over  30,000  people  visit  this  resort  annually.^  How  many 
of  these  thousands  of  people  are  carefully  studied  and  frequently 
observed  carmot  be  said,  but  in  the  rush  of  ''the  season"  many 
undoubtedly  receive  the  most  superficial  medical  treatment. 
At  Carlsbad  and  Homburg  in  the  fashionable  season  the  condi- 
tions are  probably  no  better,  and  this  notwithstanding  that  ex- 
perience has  taught  that  the  best  results  follow  strict  medical 
supervision  by  a  physician  who  can  follow  his  patient  thi'ough- 
out  his  course  and  occasionally  see  him  in  or  just  out  of  his 
bath.     In  no  other  way  can  the  patient  be  properly  guided. 

Effects  of  Baths  in  Cardiovascular  Disease. — There  is  a 
notable  discrepancy  of  opinion  as  to  the  effects  of  baths  in  cardio- 
vascular disease.  The  effect  of  hot  and  cold  douches  on  the 
blood-pressure  has  already  been  described  (see  p.  48),  and 
reference  has  alreadj^  been  made  to  the  use  of  the  sphygmoman- 
ometer and  the  sphygmograph  and  to  the  effect  of  hot  and  cold 
applications  on  the  rate  of  the  heart.  In  the  chapter  on  the 
Nauheim  Baths  reference  is  made  to  their  use  in  cardiac  disease 
(see  p.  310),  and  the  effects  of  baths  in  cases  of  arteriosclerosis 
are  referred  to  on  p.  147. 

Danger  may  be  less  apprehended  in  cases  of  aortic  and  mitral 
insufficiency  than  in  endocarditis,  myocarditis,  and  arterial  degen- 
eration; less,  also,  from  cool  baths  and  douches  than  from  hot 
baths  and  packs.  It  is  noteworthy  that  the  Nauheim  bath,  so 
beneficial  in  cases  of  cardiac  dilatation,  ranges  considerably 
below  the  body  heat.  Starting  at  95°  F.  (35°  C),  it  is  lowered  in 
successive  baths  to  90°  or  85°  F.  (32.2°  or  29.5°  C).  Simply 
because  a  patient  has  a  double  murmur  it  does  not  follow  that 
hot-air  cabinet  baths  reaching  150°  to  160°  F.  (65.6°-71.1°.C.), 
and  followed  by  needle,  jet,  and  Scotch  douches  should  not  be 
used.    The  author  has  used  such  baths  in  cases  of  this  type  with 

1  The  baths  given  in  1907  numbered  419,277. 


134  HYDROTHERAPY 

benefit  and  is  most  cautious  in  the  presence  of  arterial  degenera- 
tion with  high  blood-pressure.  Hot  as  well  as  cold  baths 
raise  the  arterial  pressure,  and  hence  these  measures  shoukl  be 
used  only  for  short  periods,  if  at  all,  with  both  elements  of  heat 
and  cold  properly  arranged  and  apportioned.  In  this  way  the 
general  circulation  is  improved  and  the  nervous  system  refreshed 
without  allowing  either  heat  or  cokl  to  make  too  positive  or  too 
prolonged  an  impression.  For  cases  of  this  type  it  is  much 
safer  and  better  to  use  the  cold  pack  at  night  preceded  and  fol- 
lowed by  friction.     Electric-light  baths  are  also  beneficial. 

The  Turkish  bath  is  especially  liable  to  be  abused,  inasmuch 
as  it  is  generally  taken  on  the  bather's  own  initiative.  Its  re- 
storative powers  after  excessive  drinking  or  prolonged  debauch 
are  well  known;  but  there  comes  a  time,  especially  in  these  cases, 
when  the  arteries  fail  to  withstand  the  strain  and  serious  acci- 
dents are  liable  to  ensue.  Cases  of  arteriosclerosis,  in  which  the 
cardiac  valves  may  be  sound  but  the  heart  muscle  degenerated, 
are  dangerous  subjects  for  the  Turkish  bath.  For  all  such  cases 
the  bath  should  not  be  more  than  tepid,  90°  to  95°  or  98°  (32.2°- 
35°  or  36.7°  C),  and  preferabl}'  prepared  more  or  less  after  the 
manner  of  the  Nauheim  bath,  with  sodium  and  calcium  chlorid 
and  possibly  with  carbonic  acid  gas.  Here,  again,  caution  is 
necessary,  for  the  effervescent  Nauheim  bath  raises  the  blood- 
pressure  slightly  for  a  few  hours.     (See  p.  429.) 

NAUHEIM  BATHS   AND   SCHOTT  TREATMENT 

Any  discussion  of  the  treatment  given  at  Nauheim  for  cardiac 
disease  naturally  includes  the  graduated  exercises  known  as  the 
Schott  resistance  exercises.  Herein  lies  much  of  the  advantage 
to  be  derived  from  a  visit  to  Nauheim,  where  these  exercises  are 
skilfully  practised.  The  tendency  outside  of  Nauheim  is  to 
attribute  the  chief  influence  to  the  baths,  and  this  belief  is  shared 
by  a  good  many  physicians  at  Nauheim.^ 

Trained  assistants  competent  to  give  these  exercises  are  now 

1  See  Jour.  Amer.  Med.  Assoc,  March  10,  1906,  p.  714. 


NAUHEIM    BATHS    AND    SCHOTT   TREATMENT  135 

found  in  the  larger  cities  of  Europe  and  America,  and  from  the 
combined  methods  a  great  deal  can  be  accomplished  outside  of 
Nauheim.  A  full  description  of  these  exercises  has  been  pub- 
lished by  Satterthwaite/  Kinnicutt,-  Schott,^  Martin  Siegfried, 
A.  Abrams,  Victor  Neesen,  ^Y.  C.  Rives,  J.  M.  Anders,*  J.  Howe 
Adams,  David  Bovaird,  Jr.,^  Douglas  Graham,  G.  W.  Norris, 
and  others. 

The  accompanying  illustrations  are  Satterthwaite's ;  they 
speak  for  themselves  as  to  the  variety  and  character  of  the  ex- 
ercises, to  the  greatest  importance  of  which  there  is  a  growing 
tendency  toward  appreciation.     (Sec  Figs.  25-39.) 

These  exercises  consist  of  slowly  conducted  flexion,  exten- 
sion, adduction,  abduction,  and  rotation,  in  orderly  succession,  of 
the  trunk,  arms,  and  lower  extremities.  Each  succeeding  move- 
ment is  resisted  by  the  attendant  with  such  force  as  to  oppose 
without  arresting  it.  Each  movement  is  slowly  and  evenly  made 
with  a.  definite  and  uniform  effort  on  the  part  of  the  patient. 
The  attendant  not  merely  resists  the  movement,  but  in  addition 
he  imposes  a  short  interval  of  rest  after  each  movement,  enjoins 
slow  and  regular  breathing,  and  prevents  any  undue  strain, 
such  as  would  be  shown  by  hurried  respiration.  He  also  bears 
upon  but  does  not  grasp  or  constrict  the  limbs.  Kinnicutt 
points  out  these  requirements  quite  fully,  showing  that  the  degree 
of  resistance  and  number  of  movements  should  be  modified  or 
discontinued  according  as  they  affect  the  pulse  and  respiration. 

The  duration  of  a  single  treatment  is,  as  a  rule,  fifteen  to 
thirty  minutes.  In  Satterthwaite's  scheme  they  range  from 
twenty-eight  to  thirty-seven  minutes,  including  the  intervals  of 
rest.  In  gentle  exercise  the  pulse  is  lessened  three  or  four  beats 
and  there  is  a  rise  of  blood-pressure.  Later  the  pressure  falls 
to  normal  and  the  pulse  is  frequently  unaltered. 

1  Thomas  E.  Satterthwaite,  International  Clinics,  vol.  i,  13th  series. 

2  F.  P.  Kinnicutt,  Boston  Med.  and  Surg.  Jour.,  May  17,  1906. 
sTheodor  Schott,  Boston  Med.  and  Surg.  Jour.,  May  16,  1907;  Medical 

Record,  March  26,  1898;  N.  Y.  Med.  Jour.,  May  11,  1907. 
*  Jour.  Amer.  Med.  Assoc,  Jan.  14,  1905,  p.  116. 
5  Medical  Times,  March,  1909. 


136 


HYDKOTHEIIAPY 


1  i^.  2't. — Choi  rai.-^ing. 


Fig.  26. — Shoulder  raising. 


Fig.  27. —  1  1    ex-  Fip;.  28. — Leg  and  thigh  flexion  and  exten- 

ten.sion  sion — exten.sion. 

Operator  indicated  by  an  X. 

(Figs.  25-39  are  from  Satterthwaite's  article  in  International  Clinics.) 


SCHOTT   RESISTANCE    EXERCISES 


137 


Fig.  30.^ — Thigh  flexion  and  extension. 


Fig.  29  — Leg  and  thigh  flexion  and 
extension — flexion. 


Fig.  31. — Trunk  flexion.  Fig.  32. — Trunk  extension. 

Operator  indicated  by  an  X. 


138 


HYDROTHERAPY 


Fig.  33. — Leg  abduction. 


Fig.  34. — Leg  adduction. 


Fig.  35. — Trunk  rotation.  Fig.  36. — .\rra  separation. 

Operator  indicated  by  an  X. 


SCHOTT   RESISTANCE    EXERCISES 


139 


Fig.  37. — Arm  opposition. 


Fig   38  — Quarter  circling.  Fig.  39. — Trunk  flexion  laterally. 

Operator  indicated  by  an  X. 


140  HYDROTHERAPY 

"The  effects  of  the  baths  and  the  Schott  exercises  are  a 
shrinkage  in  the  area  of  cardiac  dulncss  and  a  slight  upward 
movement  of  the  apex.  An  exact  radiographic  study  shows  that 
this  means  a  lessening  of  the  volume  of  the  heart.  The  duration 
of  this  diminution  in  size  is  very  short,  but  the  continued  employ- 
ment of  the  method  produces  j^ermancnt  results.  The  best 
results  are  obtained  in  cases  of  enfeebled,  relaxed,  dilated  hearts, 
with  or  without  a  murmur,  following  prolonged  and  exhausting 
diseases.  It  is  also  useful  in  cardiac  inadequacy  which  follows 
severe  muscular  effort.  In  incurable  organic  disease  the  best 
results  are  obtained  in  mitral  insufficiency  with  dilatation. 
Where  the  compensation  is  maintained  with  difficulty  and  in 
the  early  stages  of  failure  very  striking  results  are  secured. 

"The  Nauheim  treatment  is  sometimes  useful  in  cases  of 
angina  pectoris.  In  those  in  which  the  disease  is  due  to  organic 
coronary  disease,  the  prospects  are  not  so  good.  Cases  with  a 
high  vascular  pressure,  those  above  170,  should  not  be  subjected 
to  this  treatment.  In  administering  the  treatment  little  exer- 
tion and  no  fatigue  should  be  the  watchword.  Much  depends 
upon  a  careful  selection  and  instruction  of  the  operator.  There 
is  a  tendency  on  the  part  of  the  patient  to  hold  the  breath  and 
keep  the  body  rigid,  which  involves  greater  conscious  effort. 
This  must  be  avoided.  The  operator  should  be  trained  in  the 
observation  of  ordinary  symptoms.  The  use  of  too  great  resist- 
ance is  the  most  common  fault  of  the  operator  and  the  most 
difficult  to  correct.  The  resistance  exercises  alone  are  often  use- 
ful in  cardiac  inadequacy  "  (Kinnicutt). 

In  all  cases  particular  care  must  be  exercised  to  adapt  the 
baths  to  the  individual  needs.  The  process  must  be  mild  at 
the  outset ;  weak  hearts  are  never  suitable  for  strong  baths  and 
the  congestion-dilatation  of  the  heart  has  been  observed  b}'  Pratt 
and  others,  as  well  as  the  author,  to  be  distinctly  increased  by 
the  bath.  If  there  is  a  fall  in  the  blood-pressure  after  the  bath 
given  at  a  temperature  of  87°  to  92°  F.  (,30.5°-33.3°  C.)  it  indi- 
cates that  the  heart  is  weak  and  the  bath  too  strong.  Dr.  Pratt 
usually  begins  the  treatment  with  a  bath  one-fifth  or  three- 


NAUHEIM   BATHS   AND    SCHOTT   TREATMENT 


141 


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142  HYDROTHERAPY 

tenths  the  full  strength.  At  the  Medical  Baths  in  Boston  the 
attendants  take  the  blood-pressure  before  and  after  every  carbon 
dioxid  bath,  and  this  furnishes  a  most  useful  guide. 

It  is  well  to  remember  that  the  ''Nauheim  treatment" 
and  treatment  at  Nauheim  are  not  convertible  terms,  and  the 
reader  is  referred  to  a  later  chapter  in  which  these  various 
measures  are  more  fully  described.' 

Delimiting  the  Cardiac  Area. — The  most  striking  feature 
of  the  good  influence  of  systematic  resistant  exercises  and  Nau- 
heim baths  on  the  heart  is  the  contraction  of  the  cardiac  area. 
In  a  dilated  or  hypertrophied  heart  or  in  one  that  combines  both 
dilatation  and  hypertrophy  this  recession  may  be  recognized 
after  the  use  of  the  exercises  which  are  generall}^  instituted  for 
a  time  before  the  baths  begin.  During  the  period  of  bathing 
this  rise  of  the  apex-beat  and  contraction  of  area  continues  until 
the  physical  signs  plainly  show  the  improved  tone  of  the  cardiac 
muscle.  It  requires,  however,  a  good  deal  of  skill  and  experience 
to  be  able  to  map  out  accurately  the  area  of  cardiac  dulness 
and  make  a  proper  record  with  which  to  compare  future  obser- 
vations. Even  the  location  of  the  apex-beat  is  often  beset  with 
difficulty;  and  as  for  the  borders  of  the  heart,  their  limitations 
are  so  masked  by  the  pericardium,  the  thorax,  the  superficial 
fat,  varying  conditions  of  the  stomach  and  of  the  lungs,  not  to 
mention  the  possibility  of  a  mammary  gland,  that  reports  of  the 
alteration  by  |  inch  in  successive  observations  have  always 
seemed  to  the  author  beyond  the  power  of  human  recognition, 
notwithstanding  the  orthodiagraph  and  other  means  for  de- 
limiting the  cardiac  area.  Nevertheless,  in  male  subjects  with 
thin  chest-walls  changes  may  be  observed  after  a  time  by  using 
a  fixed  method  of  observation. 

Sntterthioaite's  Method  of  Delimiting  the  Cardiac  Area. — The 
best  and  simplest  plan  is  that  used  by  Satterthwaite.  He  draws 
on  the  skin  with  the  dermatographic  pencil  a  horizontal  line 
through  the  nipple  and  then  a  vertical  line  from  the  episternal 
notch  to  the  umbilicus.     He  then  traces  out  by  percussion  the 

1  See  pages  310  and  428. 


NAUHEIM   BATHS   AXD    SCHOTT   TREATMENT  143 

outline  of  the  heart  and  indicates  the  position  of  the  apex  with  an 
X.  He  then  applies  tracing-paper  to  the  chest  and  marks  on  it 
the  horizontal  and  vertical  lines,  the  outHne  of  the  heart,  and 
the  positions  of  the  apex  and  nipples.  At  each  examination 
a  similar  tracing  is  made,  and  in  this  way,  by  successive  records, 
the  changes  are  noted.  Much  will  naturally  depend  on  whether 
light  or  heavy  percussion  is  adopted,  and,  therefore,  an  effort 
should  be  made  to  use  the  same  amount  of  force  in  corresponding 
portions  of  the  cardiac  border.^ 

To  illustrate  the  method  employed,  the  following  is  a  record 
by  Dr.  Satterthwaite  of  a  young  woman  who  had  cardiac  hyper- 
trophy, mitral  regurgitation,  and  an  irritable  heart.  She  was 
slight  in  build  and  a  neurotic  subject,  addicted  to  hysteric  sur- 
prises, had  morbid  fears,  pseudo-angina,  insonmia,  and  gastric 
disturbance  with  constipation.  On  February  1  her  apex  was 
found  in  the  fifth  space,  in  the  Hne  of  the  nipple,  3|  inches  from 
the  median  line.  At  the  apex  a  harsh  and  distinct  systolic 
murmur  was  heard,  carried  to  the  left.  At  the  base  a  soft  sys- 
tolic murmur  was  heard,  confined  to  the  aortic  area.  The  heart 
sounds  were  feeble  and  the  pulse  intermittent.  The  urine 
was  normal.  After  the  preliminary  rest  and  attention  to  her 
general  condition,  she  was  given  a  limited  number  of  general 
movements,  lasting  fifteen  minutes.  These  were  given  daily  and 
gradually  increased  in  number  and  force  for  five  consecutive 
weeks.  On  February  8  the  basic  murmiu"  was  inaudible. 
The  movements  given  on  that  date  were  twelve  in  number. 
February  11,  nineteen  movements,  occupying  half  an  hour. 
February  13,  apex  3|  inches  from  the  median  line;  heart  soimds 
somewhat  stronger.  February  16,  20  movements;  pulse  96  to 
84;  respiration,  14.  February  17,  apex  3j  inches  from  the 
median  hne.  February  23,  corbonated  brine  bath,  with  resist- 
ant exercises;  apex  3|  inches  from  the  median  line.  March  1, 
apex  3  inches  from  the  median  line.  Pulse  before  the  baths, 
92;  immediately  after,  80;  later,  73.     The  patient  is  gaining 

^  See  Thomas  A.  Claytor,  Immediate  Palpatory  Percussion,  Trans.  Ameri- 
can Climatological  Assoc,  vol.  xxiv,  1908;  also  Moritz. 


144  HYDIiOTHEKAPY 

flesh.  Menstrual  flow  is  greater  than  for  five  or  six  months; 
there  is  no  insomnia.  She  now  had  occasional  attacks  of  pseu- 
do-angina, but  these  were  milder  than  previously  and  yielded 
to  monobromate  of  camphor.  Apex  now  2|  inches  from  the 
median  line  and  2\  inches  below  the  intermammary  lino. 

On  April  1  the  apex  was  1^  inches  from  the  median  line  and 
If  inches  below  the  intermammillary  line.  On  May  21  the  pa- 
tient has  had  only  one  nervous  attack  during  the  past  six  weeks; 
she  has  slept  well,  and  on  June  4  was  noted  as  still  improving. 

It  will  be  noted  that  in  this  case  there  was  a  recession  of  If 
inches  in  the  apex-beat,  and  had  it  not  been  for  the  careful  and 
systematic  records  it  would  scarcely  have  been  believed. 

Dr.  Bezley  Thornc  and  Dr.  Leslie  Thorne  Thorne  use  practi- 
cally the  same  method,  except  that  they  use  auscultatory  per- 
cussion, employing  a  light  stroke  from  a  rubber-topped  pencil, 
in  which  thoy  arc  especially  skilful. 

Enlarged  hearts  with  valvular  lesions  certainly  yield  to 
this  treatment,  and  when  dilated  and  associated  with  a  neu- 
rosis the  results  arc  often  surprising. 

It  is  only  fair  to  say  that  both  in  Nauhcim  and  in  America 
there  is  some  doubt  as  to  the  possibility  of  reducing  the  size  of 
a  dilated  or  hypertrophied  heart.  It  is  only  fair,  perhaps,  to 
hear  the  other  side. 

Dr.  David  Bovaird,  Jr.,  of  New  York,  in  a  review  of  the 
Nauheim  treatment,  has  expressed  great  skepticism  on  these 
points,  as  given  in  a  paper  before  the  Academy  of  Medicine,  New 
York,  Nov.  17,  1908: 

"Those  who  have  read  certain  publications  bearing  upon  the 
immediate  change  in  size  of  the  heart  affected  by  these  Nauheim 
baths,  have  been  greatly  impressed  with  the  tracings  shown  in- 
dicating an  immediate  reduction  in  the  size  of  the  heart  affected 
by  a  single  bath.  It  can  safely  be  said  that  there  is  doubt  of 
the  accurac}'  of  such  statements  and  that  even  after  a  long  series 
of  these  baths  in  most  cases  little  or  no  reduction  in  the  size  of 
the  heart  can  be  demonstrated  by  accurate  scientific  methods. 
Apart  from  these  specific  effects  of  the  bath,  patients  regularly 


NAUHEIM    BATHS    AND    SCHOTT   TREATMENT  145 

find  them  physically  very  agreeable,  a  judgment  which  the  writer 
can  corroborate  from  personal  experience.  The  effect  of  the 
treatment,  as  a  whole,  is  to  produce  the  first  week  or  two  a  feel- 
ing of  very  marked  lassitude,  and  weakness  of  which  most  of 
the  patients  keenly  complain;  but  gi'aduaily  the  weakness  and 
lassitude  disappear  and  the  patient  becomes  conscious  of  a 
steady  improvement,  which  is  usualty  ver}^  satisfactory." 

Cases  with  edema  or  with  renal  or  pulmonary  complications 
are  not  deemed  suitable  for  the  Nauheim  treatment. 

"The  baths  given  in  the  course  of  treatment  are  prescribed 
for  each  individual  patient  as  the  judgment  of  his  physician 
determines.  They  vary  in  their  composition  as  derived  from  one 
spring  or  another,  or  by  the  combination  of  the  waters  of  two 
springs;  in  their  temperature  for  like  reasons,  and  in  the  time  de- 
voted to  each  bath.  They  are  further  modified  by  being  given 
in  what  are  known  as  half-  and  full-baths.  In  the  half-bath  the 
water  rises  only  to  the  nipple  line  as  the  patient  sits  in  the  tub. 
In  the  full  bath,  to  the  level  of  the  chin,  the  body  being  com- 
pletely covered. 

"  The  average  cure  consists  in  taking  a  series  of  from  twenty- 
five  to  thirty  baths,  given  in  groups  of  two  or  three  at  a  time, 
with  a  rest  day  between  each  group,  and  running  in  succession 
through  the  several  grades  of  thermal,  thermal-sprudel,  and 
sprudel  baths,  the  thermal  being  regarded  as  the  mildest  of  the 
baths,  the  sprudel  as  the  most  effective.  All  of  these  baths  have 
been  used  for  many  years  and  their  effects  noted,  as  they  have 
been  modified  in  the  processes  of  a  cure.  We  have  really  very 
little  satisfactory  information  as  to  the  nature  of  their  action, 
and  the  manner  of  combining  them  appears  to  be  determined 
by  the  experience  of  the  individual  physician"  (Bovaird). 

The  author  made  a  special  effort  to  settle  in  his  own  mind 
the  uncertainty  which  naturally  arose  in  view  of  such  conflicting 
statements.  Dr.  Bezley  Thorne  very  clearly  demonstrated  to 
him,  in  his  office  in  London  in  1910,  that  by  accurate  auscultatory 
percussion  and  the  preservation  of  tracings  of  the  cardiac  area 
so  defined,  a  noteworthy  reduction  in  the  size  of  the  dilated  heart 

10 


146  HYDROTHERAPY 

actually  occurs  in  the  course  of  artificial  Nauheim  baths  with 
their  associated  resistant  movements.  The  most  carefully  made 
tracings  in  numerous  cases  convinced  the  author  that  Drs. 
Thome,  Dr.  Satterthwaite,  Dr.  Kinnicutt,  and  others,  who  have 
reported  such  changes,  are  perfectly  correct. 

Probably  a  great  help  in  recording  the  variations  in  the 
cardiac  area  will  be  found  in  the  use  of  the  orthodiagraph.  This 
instrument  has  been  used  but  very  little  as  yet  in  the  United 
States.  One  is  in  use  in  Washington,  where  Dr.  T.  A.  Claytor 
has  employed  it,  and  several  are  used  in  the  large  hospitals  in 
Continental  Europe.  The  author  saw  one  in  the  Policlinic  at 
Rome.  It  consists  of  a  combination  of  fluoroscope  and  Rontgen 
tube.  The  fluoroscopic  screen  is  provided  with  a  pencil  which 
moves  synchronously  with  the  Rontgen  tube,  so  that  the  rays 
are  always  projected  in  parallel  lines  to  the  pencil  point.  A 
double  arm  holding  the  tube  back  of  the  patient  and  the  pencil 
in  front  of  a  tablet  on  the  chest  enables  one  to  make  a  perfect 
outline  of  the  heart.  Such  an  apparatus,  when  checked  by  a 
skilful  auscultatory  percussion,  tends  to  eliminate  somewhat 
of  the  personal  equation  in  the  rather  difficult  art  of  tracing  the 
cardiac  area.  The  instrument  will  no  doubt  be  fully  tested 
and  its  possibilities  and  limitations  fully  determined.^ 

PERICARDITIS,  ENDOCARDITIS,   AND  MYOCARDITIS 

Heat  uniformly  accelerates  the  heart.  Hot  applications, 
therefore,  may  be  expected  to  stimulate  the  faiUng  heart,  es- 
pecially if  its  slow  action  be  due  to  intoxication,  exposure  to 
cold,  partial  drowning,  or  other  depressing  cause.  Cold,  on 
the  other  hand,  slows  the  rate  of  the  heart,  increases  the  arterial 
pressure,  represses  inflammation,  improves  the  tone  of  the  car- 
diac muscle,  and  relieves  pain. 

In  pericarditis  and  endocarditis  the  local  use  of  cold  is  of  the 

*  See  article  by  Schiffer  and  Weber  on  Percussion  of  Absolute  Dulness  and 
its  Value  in  the  Determination  of  the  Size  of  the  Heart,  Deutsch.  Archiv.  fiir 
Klin.  Med.,  vol.  xciv,  No.  5. 


ARTERIOSCLEROSIS  147 

highest  importance.  The  ice-bags  or  Leiter  coil  should  be  kept 
on  day  and  night,  watching  the  skin  to  see  that  no  ill  effects  re- 
sult. In  delicate  subjects  these  may  be  avoided  by  interposing 
a  little  gauze  between  the  ice-bag  and  the  skin.  In  myocarditis 
the  ice-bag  should  not  be  used  unless  there  are  distinct  signs  of 
inflammation.  Neither  should  the  resistant  exercises  practised 
in  connection  with  the  Nauheim  treatment  be  adopted,  as  a  rule, 
unless  the  myocardial  element  is  of  a  minor  character  subsidiary 
to  other  cardiac  conditions. 

ARTERIOSCLEROSIS 

In  general,  it  may  be  said  that  the  blood-pressure  is  lowered 
by  warm  applications  in  cases  of  arteriosclerosis,  whereas  cold 
applications  in  these  cases  raise  the  pressure. 

In  cases  of  nephritis,  with  arteriosclerosis  and  high  blood- 
pressure,  any  extreme  of  heat  or  cold  should  be  avoided.  Baths 
of  an  indifferent  temperature,  e.  g.,  between  95°  and  100°  F. 
(35°  and  37.8°  C),  may  be  allowed;  or  Nauheim  baths,  ranging 
from  86°  to  95°  F.  (30°-35°  C).  (See  pp.  48  and  310.)  An 
estimate  of  the  degree  of  arteriosclerosis  and  of  the  blood-pres- 
sure should  be  made  by  means  of  the  sphygmograph  and 
sphygmomanometer.     (See  pp.  49  and  52.) 

Hot  Baths  for  Arteriosclerosis.— Hirschield,  noting  that  ar- 
teriosclerosis is  the  inherent  penalty  of  strenuous  life,  meaning, 
of  course,  the  overstrenuous  life  with  excesses,  advocates  the 
systematic  employment  of  hot  baths,  which  have  given  him  ' 
favorable  results  during  the  past  two  and  a  half  years.  The 
beneficial  effect  of  the  hot  bath  upon  the  patient  suffering  from 
arteriosclerosis  is  fourfold,  as  follows: 

1.  The  distribution  of  blood-pressure  is  changed  by  the  un- 
loading of  the  internal  organs  and  the  increase  of  vasculariza- 
tion of  the  skin.  Hence  these  changes  afford  relief  in  many  of 
the  various  cases  of  pain  associated  with  internal  gout,  which  is 
so  frequent  a  cause  of  arteriosclerosis.  The  sleeplessness 
which  is  so  often  troublesome  in  arteriosclerosis  becomes  in 
a  short  time  manageable  without  drugs. 


148  HYDROTHERAPY 

2.  The  hot  bath  increases  combustion,  which  means  in- 
creased metabohsm,  increased  oxidation  of  waste  products, 
and  an  increased  respiratory  exchange. 

3.  EUmination  of  waste  products  is  increased. 

4.  Blood-pressure  is  reduced  in  the  same  manner  in  which 
the  pressure  of  water  running  from  one  tap  is  lowered  as  soon 
as  another  tap  is  turned  on.  The  patient  is  bled  into  the  skin, 
and  the  pulse  at  once  becomes  faster  and  more  frequent.  The 
systematic  emjiloymc^it  of  the  hot  l)ath  at  last  (establishes  an 
increased  vascular  habit  of  the  skin,  thus  permanently  lowering 
blood-pressure. 

The  oxygen  hath,  lately  introduced,  is  said  to  have  a  good 
effect  by  reducing  the  blood-pressure  in  arteriosclerosis.  (See 
p.  323.) 

TOXEMIC   MYOCARDITIS 

In  toxemic  myocarditis,  whether  from  (lii)htheria,  scarlet 
fever,  typhoid  fever,  pneumonia,  or  other  infection,  it  is  highly 
necessary  to  supply  artificial  heat  to  the  body  by  means  of  hot- 
water  bags  in  connection  with  gentle  massage.  Hot  normal 
saline  colonic  flushings  at  about  115°  F.  (46.1  °  C.)  will  often  rouse 
a  poor  circulation;  especially  is  this  the  case  in  the  intestinal 
paresis  that  may  accompany  a  pneumonia. 

Another  measure  not  to  be  neglected  is  the  mustard  foot-bath. 
A  little  mustard  is  placed  in  cheese-cloth  and  added  to  a  foot- 
bath at  100°  F.  (37.8°  C.)  and  the  feet  loathed  for  one  minute. 
This  may  be  repeated  in  an  hour. 

Murphy's  method  of  proctoclysis,  in  which  large  quantities 
of  water  are  slowly  absorbed,  is  not  at  all  suitable  for  cases 
complicated  by  pneumonia,  and  is  positively  dangerous  in  any 
advanced  stage  of  that  disease. 

CHRONIC  RHEUMATIC  MYOSITIS;  LUMBAGO 

This  condition  is  characterized  by  indurations  due  to  some 
autotoxic  metabolic  disturbance  anrl  is  amenable  to  treatment, 
not  too  violent,  which  favors  restoration  of  good  circulation. 


alcoholism;  morphinism  149 

Tepid  baths  and  hot  dry  packs  are  indicated.  Moderate  rubbing 
during  the  bath  may  be  employed,  but  any  systematic  or  vigorous 
massage  is  hable  to  bring  on  acute  painful  conditions  simulating 
rheumatism.  When  situated  in  the  neck  or  shoulder,  this  form 
of  myositis  is  very  troublesome,  especially  before  the  usual  hour 
of  waking.  It  wears  off  as  the  day  advances  and  as  voluntary 
motion  favors  a  more  vigorous  circulation  than  during  the  period 
of  rest.^ 

ALCOHOLISM;  MORPHINISM;  CHRONIC  LEAD-,  MER- 
CURY-, AND  ARSENIC-POISONING,  AND  TOBACCO 
HABIT 

This  is  one  of  the  most  favorable  fields  for  hydrotherapy. 
In  acute  cases  the  Turkish  bath  yields,  as  a  rule,  immediate  re- 
sults. If  this  be  not  convenient,  a  prolonged  soaking  in  the  warm 
full  bath  at  a  temperature  of  100°  to  102°  F.  (37.8-39.9°  C), 
followed  by  friction  and  rest  in  bed  may  be  emplpyed. 

Chronic  alcoholism  is  best  treated  by  the  use  of  tub-baths 
at  102°  to  104°  F.  (39.9°-40°  C.)  for  ten,  fifteen,  or  twenty 
minutes,  followed  by  packs  in  hot  blankets  for  similar  periods. 
Cases  demand  treatment  in  accordance  with  the  general  phys- 
ical condition.  The  corpulent,  robust  man  may  or  may  not  have 
a  good  cardiac  and  circulatory  system  and  the  immediate  effect 
of  these  procedures  must  be  observed.  If  they  are  well-borne, 
these  measures  may  be  pushed  to  the  higher  limit  and  followed  by 
cold  sponging  or  cold  douches.  (For  the  neuritis  resulting  from 
abuse  of  alcohol  see  under  "Neuritis.") 

Measures  similar  to  those  employed  in  alcoholism  may  be 
adopted  in  chronic  lead-  and  mercury-poisoning  and  morphin 
and  tobacco  habitues.  Tonic  measures  and  the  use  of  the  hot-air 
cabinet,  followed  by  the  circular  douche,  jet,  Scotch,  and  fan 
douche,  and  an  alcohol  rub  will  be  required  where  there  is  debility, 
and  especially  after  a  course  of  tubs  and  packs. 

The  internal  use  of  waters,  particularly  those  containing 

1  N.  S.  Yawger,  The  Lancet,  July  31,  1909.  See  also  Sir  W.  R.  Gowers 
on  Lumbago,  Brit.  Med.  Jour.,  Jan.  16,  1904^  p.  117. 


150  htdrothp:rapy 

magnesium  sulphate,  aids  in  the  treatment  of  these  patients. 
Among  the  most  successful  resorts  in  America  for  cases  of  this 
class  are  French  Lick  and  West  Baden,  Indiana.  It  is  the  custom 
there  for  patients  to  rise  early,  about  5  o'clock  during  the  milder 
season,  and  drink  several  glasses  of  the  Pluto  Spring  water.  It  is 
laxative  and  diuretic  and  has  the  great  advantage  of  annulling,  for 
a  time  at  least,  the  craving  for  alcoholic  liquors.  The  author 
has  had  repeated  testimony  on  this  point  and  has  been  impressed 
with  the  results  which  have  been  obtained  in  a  comparatively 
short  period.  Several  quarts  or  even  gallons  of  this  water  are 
taken  daily  by  the  thousands  of  visitors  who  visit  these  resorts 
from  Chicago,  St.  Louis,  Cincinnati,  and  other  cities  in  the  United 
States. 

In  delirium  tremens  the  hot  wet  blanket  pack  is  very  useful 
in  calming  the  patient  and  promoting  sleep. 

DIGESTIVE  DISORDERS 

These  affections  are  most  obstinate,  being  usually  constitu- 
tional or  of  slow  onset,  and  controlled  by  long-standing  habits  of 
the  body  which  require  months  or  years  of  well-directed  treatment 
to  correct.  Medicinal  treatment  without  dietetic,  hygienic,  and 
hydrotherapeutic  measures  is  as  "sounding  brass  or  as  a  tink- 
ling cymbal,"  to  use  the  historic  phrase.  Patients  with  chronic 
gastro-intestinal  disease  are  frequently  depressed  in  spirit,  do 
not  sleep  well,  and  arc  loath  to  acknowledge  improvement  if  it 
occur.  By  the  employment  of  hydrotherapy  sleep  may  be  im- 
proved and  the  abdominal  circulation  stimulated  in  such  a  way 
as  to  favor  the  elimination  of  toxic  materials,  especially  when 
suitable  mineral  waters  are  administered.  These  latter,  how- 
ever, are  often  used  without  any  judgment.  Stomachs  can  easily 
be  ruined  by  pouring  in  large  quantities  of  water  containing 
sulphate  or  carbonate  of  lime  or  using  strong  solutions  of  lithium 
carbonate  as  prepared  by  dissolving  the  tablets  at  the  table. 


CONSTIPATION  151 


CONSTIPATION 


In  fairly  robust  persons  whose  circulation  is  good  the  applica- 
tion of  a  cold  pack  or  compress  to  the  abdomen  every  morning 
may  be  given  a  preliminary  trial.  The  cold  compress  should  be 
changed  once  or  twice  during  the  ten  or  fifteen  minutes  of  the 
application.  Where  there  are  suitable  appliances,  a  cold  douche 
at  65°  or  60°  F.  (18.3°  or  15.6°  C.)  may  be  applied  for  one  or  two 
minutes  at  15  to  20  pounds'  pressure.  This  will  probably  give 
better  results  in  obstinate  cases  than  the  compress  or  pack. 
The  reaction  which  ensues  is  accompanied  by  an  increase  of  blood 
in  the  abdominal  vessels,  thus  favoring  functional  activity. 

In  patients  not  so  robust,  and  with  sluggish  circulation,  a 
hot  douche  or  warm  application  may  be  made  at  first,  and  later 
the  temperature  may  be  lowered  on  successive  days. 

Compresses  are  more  suitable  for  old  and  feeble  patients  than 
the  more  formidable  treatment  by  douches.  As  many  cannot 
incur  the  expense  or  inconvenience  of  institution  treatment, 
simpler  measures  are  more  likely  to  be  adopted.  The  cold  com- 
press, or  Neptune's  girdle,  placed  over  the  abdomen  and  renewed 
every  four  hours,  may  afford  the  desired  stimulus.     (See  p.  356.) 

In  spastic  constipation,  all  forms  of  colic  and  muscular 
rigidity  accompanying  inflammatory  conditions,  fomentations 
must  be  used.  They  should  be  of  generous  dimensions,  extending 
well  beyond  the  borders  of  the  irritable  and  painful  area,  should 
be  wrung  dry  to  avoid  blistering,  and  should  be  changed  every 
five  or  ten  minutes  and  covered  with  rubber  or  any  permeable 
material  which  will  retain  the  heat.  One,  two,  or  more  layers 
of  thick  cloth,  flannel,  or  felt  make  a  satisfactory  medium  to 
carry  the  water.  When,  in  addition  to  heat,  a  counterirritant 
is  desired,  a  small  amount  of  mustard  or  turpentine  may  be  added 
to  the  water  for  the  fomentations  (Gant).  A  hot- water  coil 
may  be  used,  but  is  not  so  efficacious;  the  covered  electric  com- 
press or  cushion  will  be  found  very  useful. 

Chronic  Constipation. — The  atonic  variety  and  the  spastic 
variety  should  be  carefully  distinguished.     In  the  former,  every 


152  HYDROTHERAPY 

measure  tending  to  improve  the  tone  of  the  muscular  system  is 
called  for.  If  possible,  the  hot-air  or  electric  cabinet  should  be 
used  to  produce  perspiration,  followed  by  circular  jet,  Scotch, 
and  fan  douches.  These  measures  should  then  be  followed  by 
skilful  abdominal  and  general  massage: 

Hot-air  bath  to  gentle  perspiration. 

Circular  douche,  105°  to  95°  F.  (40.G°-35.°  C),  one  minute; 
20  pounds. 

Scotch  douche,  ^-inch  nozzle  to  the  course  of  the  colon,  G0° 
•and  112°  F.  (15.6°  and  44.5°  C),  fifteen  seconds  each,  alter- 
nating for  one  or  two  minutes;  20  pounds. 

Fan  douche  to  chest  and  back,  75°  F.  (23.9°  C),  ton  seconds; 
20  pounds.  Repeat  dail}^  increasing  pressure  1  pound  daily 
until  30  poimds  are  used.     Walk  in  the  open  air  afterward. 

Or  the  following : 

Wet  pack;  temperature  of  w^ater  60°  to  70°  F.  (15.6°^ 
21.1°  C),  one  hour.  Circular  douche,  85°  F.  (29.4°  C),  fifteen 
seconds;  20  pounds.  Repeat  daily.  Once  or  twice  a  week  a 
circular  douche  at  90°  to  75°  F.  (32.2°-23.9°C.).  Fan  douche, 
85°  to  65°  F.  (29.4°-18.3°  C),  five  seconds;  20  pounds. 

The  differential  diagnosis  between  atonic  and  spastic  con- 
stipation is  often  very  difficult  and  sometimes  impossible.' 

Spastic  constij)ation  is  stated  to  be  found  more  frequently 
the  more  carefully  it  is  sought  for.  In  the  female  at  least  25 
per  cent,  of  the  cases  are  of  this  form;  and  many  of  the  most 
persistent  cases  of  chronic  constipation,  refractory  to  all  n:ieth- 
ods  of  treatment,  are  of  this  type.  As  the  treatment  of  this 
form  of  constipation  is  diametrically  opposite  to  the  atonic 
form,  it  is  not  diflficult  to  see  why  so  many  patients  with  con- 
stipation arc  treated  for  years  without  success. 

Spastic  constipation,  according  to  Dr.  Albu,  is  most  fre- 
quently found  in  neurasthenic  and  hysteric  individuals,  most 
often  females.  They  are  weak,  poorly  nourished,  somewhat 
pale  and  anemic,  and  in  the  third  or  fourth  decade  of  life. 

A  perfect  knowledge  of  the  syndrome  of  the  malady,  there- 

lA.  Albu,  of  Berlin,  in  Med.  Record,  July  1,  1905. 


GASTKOPTOSIS  153 

fore,  must  be  obtained  in  order  to  outline  an  intelligent  course 
of  treatment. 

As  these  spasms  sometimes  develop  on  the  basis  of  atony, 
every  occasion  for  exciting  them  must  be  avoided.  Every  irri- 
tation of  the  intestines,  and  especially  massage,  which  is  very 
effective  in  the  atonic  form  of  constipation,  must  be  avoided. 
Albu  recommends  the  use  of : 

Warm  or  hot  sitz-baths  for  from  fifteen  to  twenty  minutes  at 
a  time. 

The  application  of  hot  compresses  to  the  abdomen,  which 
not  only  lessen  the  spasm  but  also  relieve  the  colic. 

Chronic  constipation  has  sometimes  been  cured  by  inject- 
ing into  the  bowel  |  pint  of  cold  water  on  rising,  and  retain- 
ing this  until  after  breakfast.  If  too  cold,  retention  may 
be  impossible,  but  the  bowel  can  be  accustomed  to  hold  this 
quantity  by  properly  grading  the  temperature.  Cold-water 
enemata  can  be  more  readily  dispensed  with  than  large  warm 
enemata. 

Warm  enemas  of  linseed  oil  or  olive  oil,  j  liter  every  evening, 
given  in  bed,  with  the  hips  elevated  or  in  the  knee-elbow  po- 
sition, and  retained  over  night  if  possible.  The  object  of  this 
treatment  is  not  to  produce  bowel  movements,  but  to  act  as 
a  sedative  on  the  spasm  of  the  intestinal  muscle,  and  should, 
therefore,  remain  in  contact  with  it  as  long  as  possible. 

Large  warm  enemata  are  liable  to  engender  the  enema  habit. 
This  may  be  broken  by  lowering  the  temperature  of  the  water 
each  day  5  degrees,  and  lessening  the  amount  |  pint. 

GASTROPTOSIS 

Gastroptosis  may  be  treated  by  the  following  procedure, 
advocated  by  Dr.  George  Roe  Lockwood : 

About  11  o'clock  in  the  morning  a  warm  or  hot  bath  at 
105°  F.  (40.5°  C.)  is  given  for  five  minutes.  This  is  followed  by 
a  spinal  douche  at  100°  to  102°  F.  (37.8°-39.9°  C.)  for  ten 
seconds  at  15  to  20  pounds'  pressure.  The  patient  is  then  placed 
in  bed  and  a  hot  wet  flannel  compress  or  one  of  spongiopiline 


154  HYDROTHERAPY 

suflficiently  large  to  cover  a  good  portion  of  the  abdomen  is  placed 
on  the  epigastrium.  This  is  kept  hot  by  a  covered  electric  pad 
and  is  changed  every  two  hours  by  day  and  once  at  night.  The 
whole  application  is  to  be  tightly  applied  by  an  elastic  binder.' 

CHRONIC  GASTRITIS  AND  ENTERITIS 

In  these  conditions  the  half-bath,  which  combines  moisture, 
temperature,  friction,  and  force,  is  a  favorite  measure  abroad. 
(For  technic  see  p.  243.)  It  may  be  followed  by  the  pail-pour, 
which  consists  of  pouring  water  from  a  pail  held  about  4  feet 
above  the  patient.  This  pail-pour  is  repeated  three  to  six  times. 
It  seems  to  enhance  the  good  effect  of  the  bath.  Winternitz 
has  termed  this  thermic  massage.  The  hot-air  bath  may  be 
used  previous  to  the  half-bath,  producing  a  stimulating  and 
refreshing  sensation  and  a  tonic  improvement. 

ROUND  ULCER  OF  THE  STOMACH;  HEMORRHAGE 

In  this  affection  apply  a  cold  compress  to  the  stomach, 
•covering  this  with  a  coil  through  which  ice-water  flows  continu- 
ously for  several  days  if  necessary.  A  sheet  may  be  wrung  out 
of  cold  water,  laid  over  the  trunk,  tucked  in  at  the  sides,  and  the 
■cold  coil  placed  on  top  of  this. 

In  the  hyperesthesias  of  gastric  disorders  the  electric  heating 
pad  to  the  stomach  and  warm  hip-bath  freciuontly  afford  relief. 

Sadgcr  has  given  his  experience  with  hydrotherapy  in  the 
•case  of  hemorrhage  from  gastric  ulcer. ^  He  states  that  he  has 
often  found  that  small  pieces  of  ice  introduced  into  the  rectum 
act  like  magic  in  arresting  acute  hcmatemesis.  Cold  fluids 
introduced  into  the  rectum,  he  found,  reduce  the  temperature 
•of  the  stomach  in  some  way.  Swallowing  scraps  of  ice  has  the 
opposite  effect,  and  actually  favors  hemorrhage  as  the  water 
accumulates  and  becomes  warm.  A  cold  coil  over  the  stomach, 
over  a  cold  compress,  is  an  effectual  adjuvant,  the  flow  of  ice- 
cold  water  through  the  coil  being  kept  up  continuously  possibly 

1  Medical  Record,  July  20,  1007. 

2  Abstract  in  Jour.  Amer.  Med.  Assoc,  April  14,  1906. 


ROUND    ULCER   OF   THE   STOMACH;   HEMORRHAGE  155 

for  a  week.  A  sheet  is  wrung  out  of  cold  water  and  laid  over 
the  trunk,  tucked  in  around  the  sides,  and  over  this  the  cold 
coil  is  applied  over  the  stomach.  The  patient  is  fed  with  tepid 
sweet  or  sour  milk  in  small  portions  for  four  or  five  weeks. 
Sadger  commences  with  a  teaspoonf ul  every  fifteen  minutes 
and  increases  the  amount  to  a  tablespoonful,  then  to  half  an  after- 
dinner  cofTeecupful,  and  finally  to  a  teacupful,  increasing  the 
intervals  to  thirty  or  sixty  minutes.  He  insists  on  this  diet 
after  acute  hemorrhage  and  also  in  the  treatment  of  chronic  ulcer. 
Even  on  the  day  of  the  hemorrhage  it  is  possible  to  commence 
with  minimal  amounts  of  the  milk  (ice  cold).  Sadger  quotes 
from  Winternitz  that  the  factors  inducing  round  ulcer  of  the 
stornach  are  a  chlorotic  tendency,  reduction  in  hemoglobin, 
reduced  alkalinity  of  the  blood  and  hyperacidity  of  the  gastric 
juice,  with  spasmodic  contraction  of  the  blood-vessels  in  the 
stomach  mucosa.  These  factors,  he  says,  induce  a  predisposition 
to  gastric  ulcer.  Hydrotherapy,  which  has  such  a  powerful 
action  on  all  these  factors,  forms  thus  a  truly  causal  treatment 
for  the  resulting  predisposition  to  gastric  ulcer.  It  seems  to 
be  the  general  experience  that  the  main  contingent  of  gastric 
ulcers  is  presented  by  chlorotic  girls.  The  chief  reliance  is  on 
general  stimulating  measures,  with  procedures  to  influence  the 
circulation  in  the  stomach  fining  and  walls.  These  include  cold 
sitz-baths  for  about  four  minutes,  stimulating  packs,  generally 
in  combination  with  the  hot  coil,  which,  however,  is  never  left 
in  place  for  more  than  ten  or  fifteen  minutes.  Sometimes  the 
cold  coil  is  applied  to  the  heart  to  improve  the  general  and  local 
circulation.  These  measures  are  supplemented  by  a  strict  milk 
diet.  Sadger  applies  an  abdominal  pack,  changed  every  three 
hours.  Once  or  twice  a  day  a  coil  of  hot  water  (104°  F. — 40°  C.) 
is  inserted  in  the  pack  for  ten  or  fifteen  minutes.  Once  a  day  a 
sitz-bath  is  taken  with  water  at  46°  or  57°  F.  (7.7°  or  13.8°  C.) 
for  from  three  to  five  minutes.  Early  in  the  morning  the  body 
is  rubbed  off  with  a  cloth  wrung  out  of  very  cold  water,  avoiding 
the  chest  and  abdomen.  Later,  alternating  hot  and  cold  pro- 
cedures are  used.     A  good  arrangement  for  home  use  is  a  cold 


156  HYDROTHERAPY 

pack  until  the  sheet  gets  warm  (twenty  to  thirty  minutes),  with 
a  half-bath  afterward  at  68°  or  70°  F.  (20°  or  21.1°  C.)  for  two 
or  three  minutes.  Milk  is  the  only  food  allowed  for  four  or  five 
weeks,  commencing  with  a  teaspoonful  every  fifteen  minutes. 
The  milk  must  always  be  very  slowly  sipped. 

ATONY  AND  ENTEROPTOSIS 

Atony  and  enteroptosis  may  also  be  helped,  when  spastic 
constipation  is  absent,  by  cold  abdominal  douches,  such  as  mild 
jet  and  fan  douches,  and  by  abdominal  massage.  The  prelimi- 
nary warm  bath,  hot-air  bath,  or  electric-light  bath  until  per- 
spiration is  free  is  followed  by  a  short  cold  application  admin- 
istered by  rubbing  the  patient  with  a  mitten  or  coarse  towel  wet 
with  water  at  about  60°  F.  (15.6°  C),  or  by  giving  the  patient  a 
cold  douche  at  70°  to  60°  F.  (21.1  °-15.()°  C.)  for  five  to  twenty 
seconds.  The  temperature  should  be  lowered  1  degree  daily  and 
the  pressure  increased  by  1  pound  fi-om  15  to  a  maximum 
of  30  pounds.  This  stimulates  the  circulation,  prevents  auto- 
intoxication, and  improves  the  muscular  tone:  Intestinal  lavage 
and  irrigation  are  also  useful.  This  may  relieve  the  "morning 
diarrhea"  of  atonic  dilatation  of  the  stomach. 

NERVOUS  DYSPEPSIA 

The  measures  described  for  aton}^  and  enteroptosis  are  some- 
times useful  in  nervous  dyspepsia.  If  a  choice  can  be  made 
that  is  practicable  and  that  can  be  adopted  for  two  months  or 
more,  an  impress  can  usually  be  made  on  this  obstinate  affection. 

Thesitz-bath  at  50°  to  60°  F.  (10°-15.6°  C.)  for  three,  five, 
or  eight  minutes  is  also  beneficial. 

General  tonic  measures,  such  as  electric-light  baths  followed 
by  douches,  are  indicated,  but  these  cases  are  proverbially 
obstinate.  It  should  be  stated  in  this  connection  that  the 
general  effect  of  cold  bathing  is  to  diminish  intestinal  putrefac- 
tion. 


CHOLERA   INFANTUM  157 

PERISTALTIC  UNREST 

In  the  condition  known  as  peristaltic  unrest  of  Kussmaul  the 
hydrotherapeutic  measures  used  for  neurasthenia  should  be 
tried.  These,  with  lavage  of  the  lower  bowel,  give  very  satisfac- 
tory results. 

CHOLERA  INFANTUM 

When  the  temperature  is  high,  bathing  should  be  employed  at 
a  temperature  of  only  a  few  degrees  below  that  of  the  body. 
The  warm  mustard  bath,  made  with  one  or  two  tablespoonfuls 
of  mustard  enclosed  in  cheese-cloth  and  placed  in  a  small  tub  of 
water  at  98°  to  100°  F.  (35°-37.8° C),  may  be  used.  The  child, 
whose  ears  are  protected  with  a  little  cotton  plug,  is  put  in  the 
bath  at  the  same  time  that  the  mustard  is  added  at  the  foot  of 
the  bath-tub.  The  duration  of  the  bath  may  be  from  four  to 
five  or  eight  minutes  or  until  the  person  holding  the  child  finds 
some  reddening  of  her  own  skin.  The  child  is  then  dried  and 
dressed  in  night  clothes  and  returned  to  bed.  Marked  im- 
provement of  the  general  circulation  and  the  breathing,  and  a 
quieting  effect  on  the  general  nervous  system  will  be  noted  as 
the  results. 

Cold  baths  and  ice- water  injections  into  the  bowels  are  not  to 
be  recommended,  although  they  have  been  advocated  by  some. 
When  no  reaction  follows  the  mustard  bath  the  prognosis  is 
not  good. 

Dr.  Forchheimer  acids  a  word  of  caution  regarding  the  eyes  in 
giving  mustard  baths  to  children.  The  eyes  should  be  kept  clean 
and  protected  not  only  in  the  mustard  bath,  but  throughout 
the  course  of  cholera  infantum  in  order  to  prevent  infection. 
Normal  salt  solution,  with  boric  acid,  if  necessary,  should  be 
dropped  into  the  conjunctival  sac,  and  when,  as  is  usually  the 
case,  the  lids  are  open  the  eyes  should  be  kept  constantly  covered 
with  moistened  lint  to  prevent  ulcer  of  the  cornea.  (See  also 
p.  227.) 


158  HYDROTHERAPY 

PERITONITIS  AND  APPENDICITIS 

Cold  applications  are  to  be  preferred  to  hot  ones  in  these 
comlitions.  In  general  peritonitis  cold  is  applied  by  means  of 
ice,  using  the  ice-poultice  or  ice-bags.  These  measures  are  also 
indicated  in  appendicitis  previous  to  operation.  The  bag  should 
be  suspended  so  as  not  to  rest  too  heavily  on  the  patient.  Too 
persistent  application  of  cold  acts  as  a  marked  depressant,  and 
unless  gauze  is  interposed,  ice-bags  and  ice  directly  applied  to  the 
abdominal  wall  may  produce  gangrene.  Such  accidents  have 
happened  and  have  given  rise  to  law  suits. 

Cloths  wet  in  ice-water  may  be  used  instead  of  the  ice-bag, 
changed  frequently. 

Murphy's  method  of  proctoclysis  has  yielded  good  results  in 
these  cases.     (See  p.  361.) 

SEASICKNESS 

The  full  hot,  dry  pack  to  the  entire  body,  including  the 
head,  is  a  simple  effective  remedy  for  seasickness.  This  should 
be  kept  up  until  the  superficial  vessels  are  fully  dilated.  Hot 
towels  to  the  head  are  also  useful  at  times.  The  electric  pad 
applied  to  the  stomach  is  nowadays  a  practical  measure  on  the 
ocean  steamers. 

ANEMIA;  CHLOROSIS;  CONVALESCENCE  FROM 
ACUTE  ILLNESS 

In  treating  these  affections  the  aim  is  to  stimulate  all  the 
sources  of  the  body  heat  to  a  powerfully  increased  function. 
The  first  step  is  to  warm  the  body,  applying  afterward  vigorous 
brief  thermic  and  mechanical  stimulation  of  the  nerves.  Nothing 
accomplishes  this  so  well  as  the  hot-air  cabinet  succeeded  by  the 
circular  douche,  jet,  and  Scotch  douches,  followed  then  by  an 
alcohol  rub. 

ANEMIA 

Great  improvement  follows  judicious  hydrotherapy  in  this 
disease.     To  improve  the  circulation,  the  digestion,  and  the 


ANEMIA  159 

excretion  are  the  main  aims.  These  may  be  attained  by  warm 
baths  or  cold  baths;  by  hot-air  baths  followed  by  appropriate 
douches,  the  so-called  tonic  baths;  by  drip  sheets,  cold  packs, 
and  the  judicious  use  of  nearly  every  hydrotherapeutic  measure. 
Cases  of  pernicious  anemia  are  sometimes  arrested  and  started 
toward  recovery  by  these  methods  in  connection  with  internal 
treatment.  At  times  internal  treatment  is  not  well  borne,  and 
physiologic  therapeutics  become  the  mainstay. 

In  mild  grades  of  anemia  with  fair  resistance,  the  author 
usually  employs  the  hot-air  cabinet  or  the  electric-light  cabinet, 
followed  by  the  circular  douche,  jet  douche,  Scotch  douche,  fan 
douches,  and  a  drying  rub  and  friction  with  alcohol.  The  pre- 
scription may  read  as  follows : 


Hot-air  bath,  eight  to  ten  minutes  or  to  beginning  perspiration. 
Circular  douche,  two  minutes,  105°  to  90°  F.  (40.6°-32.2°  C),  20  pounds. 
Jet  douche,  one  minute,  100°  to  80°  F.  (37.8°-26.7°  C),  20  pounds. 
Scotch  douche,  twenty  seconds,  105°  and  80°  F.  (40.6°  and  26.7°  C),  20 

pounds. 
Fan  douche,  ten  seconds  at  78°  F.  (25.6°  C). 
Alcohol  rub.     Reduce  minima  1  degree  daily  to  60°  F.  (15.6°  C). 


When  cabinets  and  douches  are  not  available,  simpler  meas- 
ures, such  as  the  systemic  use  of  the  drip  sheet  at  bedtime,  the 
half-bath,  warm  or  cold  l)aths,  followed  by  friction,  may  be  em- 
ployed. Warm  salt-water  baths  are  useful.  In  summer  sea- 
baths  at  moderate  temperatures  and  sun  baths  on  the  beach 
before  and  after  the  bath  may  be  helpful,  but  have  to  be  taken 
with  judgment.  In  this  way  a  good  reaction  is  obtained  and 
the  tone  of  the  skin  is  greatly  improved. 

In  extreme  anemia  the  patient  is  usually  too  weak  to  stand 
while  douches  are  administered,  and  hence  graduated  brine  baths 
with  effervescing  carbon  dioxid  are  recommended  and  can  easily 
be  carried  out  at  home.  The  natural  carbon  dioxid  baths  at 
Nauheim,  Carlsbad,  and  elsewhere  may  be  taken  where  the 
means  and  convenience  of  the  patient  permit.  Baths  containing 
iron  sulphate  are  useful  for  their  astringent  and  bactericidal 


160  HYDROTHERAPY 

effect  on  the  mucous  membranes,  especially  where  vaginal  ca- 
tarrh is  associated  with  the  anemia. 

In  employing  hot  baths  it  is  best  to  give  them  on  alternate 
days  at  first,  so  that  the  patient  can  have  massage  and  uninter- 
rupted outdoor  rest,  with  perhaps  moderate  exercise,  on  the 
intervening  days.  The  best  time  for  these  baths  is  in  the  fore- 
noon and  about  two  hours  after  breakfast.  The  temperature 
should  be  from  102°  to  104°  F.  (38.9°-40°  C).  At  fir.st  of 
ten  minutes'  duration,  the  bath  may  be  lengthened  to  twenty 
minutes.  A  cool  or  cold  cloth  is  kept  on  the  entire  scalp  and 
frequently  wrung  out  in  cold  water  during  the  progress  of  the 
bath.  Rubbing  in  the  tub  is  advised.  When  the  patient  is 
taken  out  he  is  sponged  up  and  down  the  spine  or  all  over  with 
water  at  70°  F.  (21  °C.),  and  in  this  way  is  educated  to  the  use 
of  a  cold  douche  by  the  time  for  the  third  or  fourth  bath.  The 
cold  water  from  a  hose  may  be  gradually  lowered  in  tem- 
perature as  the  treatment  progresses  and  the  patient  gains 
strength. 

If  the  patient  is  not  too  weak,  the  Turkish  bath  is  useful  in 
promoting  good  circulation  and  improving  the  condition  of  the 
blood,  particularly  is  it  beneficial  if  associated  with  a  redundance 
of  fat.  In  this  latter  connection  massage  is  a  most  valuable 
adjunct.  (For  the  effect  of  hot  and  cold  applications  on  the 
blood  and  the  blood-vessels,  see  pp.  50  and  210.) 

CHLOROSIS 

Cold  sitz-baths  for  about  four  minutes  or  stimulating  hot 
packs,  generally  in  combination  with  the  hot  coil,  favor  circula- 
tion in  the  stomach-lining  and  walls,  and  are  suitable  in  chlorosis. 
The  hot  coil  should  be  left  in  place  not  over  ten  or  fifteen  minutes. 

The  cold  coil  may  be  applied  to  the  heart  to  improve  the 
general  and  local  circulation  (see  pp.  102  and  357). 

Nearly  all  cases  can  be  benefited  by  some  system  of  neuro- 
vascular training  by  hydrotherapy. 

The  following  prescription  is  suitable  for  moderate  cases  of 
chlorosis  and  anemia: 


SPLENIC    ENLARGEMENT  161 

Electric-light  bath,  fifteen  to  twenty  minutes. 

Fan  douche,  105°  F.  (104.5°  C),  thirty  seconds,  20  pounds. 

Fan  douche,  70°  F.  (21°  C),  fifteen  seconds,  20  pounds. 

Dry  rub. 

Rest  one  hour. 

Repeat  every  other  day. 

If  the  patient  is  rather  weak,  the  time  in  the  electric-light 
cabinet  may  be  shortened,  and  instead  of  the  douche  give  a  cold 
wet  mit  friction  with  water  at  70°  F.  (21°  C),  reducing  it  daily 
1  degree. 

VASOMOTOR  SPASM  AND  VISCERAL  ANEMIAS 

Hot  mud  baths  are  sometimes  of  great  benefit.  Mountain 
spas  are  of  great  value  in  anemia  and  chlorosis. 

For  vasomotor  spasm  and  visceral  anemias  such  measures 
as  the  general  Scotch  douche,  warm  visceral  or  abdominal 
douches,  short  percussion  douches,  alternate  hot  and  cold  com- 
presses, etc. ,  are  very  effective.  Cold  sponging  over  the  spine  and 
outside  and  inside  of  thighs  increases  elimination  and  stimulates 
circulation.  Constipation  may  be  relieved  and  peristaltic  activ- 
ity increased  by  drinking  a  glass  of  cold  water,  preferably  car- 
bonated water,  before  breakfast;  small  cold  enema;  fomenta- 
tion with  water  at  120°  F.  (48.8°  C.)  over  hver  twice  daily, 
followed  by  heating  compress  during  interval;  wet  girdle  at 
night;  cold  fan  douche  to  abdomen;  cold  percussion  douche  to 
spine;  abdominal  massage.  Douches  generally  act  better  when 
preceded  by  some  warming  process. 

SPLENIC  ENLARGEMENT 

Mosler^  states  that  the  application  of  cold  water  to  the  ab- 
domen produces  contraction  of  the  spleen,  and  that  the  cold 
douche  appHed  for  two  or  three  minutes,  and  repeated  at  longer 
or  shorter  intervals,  very  sensibly  affects  the  enlarged  spleen  of 
intermittent  or  typhoid  fever  and  even  of  such  chronic  diseases 
as  leukemia,  in  which  class  of  cases  the  application  should  be 
twice  a  day  (H.  C.  Wood). 

1  Virchow's  Archiv  fiir  Path.  Anat.  und  Phys.,  Ivii. 
11 


102  HYDROTHERAPY 

NEURASTHENIA 

Most  neurasthenics  are  benefited  by  hydrotherapy  and 
nearly  all  of  the  various  baths  that  promote  healthy  reaction 
may  be  employed.  The  best  of  these  are  the  drip  sheet,  alter- 
nate hot  and  cold  sponging  of  the  spine,  the  tonic  treatment 
by  means  of  the  hot-air  cabinet,  the  circular  douche,  jet,  Scotclj 
and  fan  douches,  and  subsequent  rub. 

The  salt  rub,  preceded  and  followed  by  a  spray  or  fan  douche, 
is  an  excellent  measure  and  easily  applied  (see  p.  354).  The 
temperature  of  the  spray  should  be  between  92°  and  99°  F.  (33.3° 
and  37.2°  C.)  and  should  occupy  from  four  to  eight  minutes. 
Beni  Barde,  of  Paris,  applies  the  sj^ray  along  the  spine,  then  the 
anterior  surface,  and  then  the  limbs,  making  the  application 
twice  a  day. 

If  all  sudden  shocks  are  avoided,  sleep  is  favored,  nervous 
agitation  ceases,  and  the  patient  is  generally  soothed.  The 
temperature  of  the  bath  toward  the  end  may  be  reduced  a  trifle. 

Cool  or  cold  water  bathing  is  not  always  beneficial  to  the 
neurasthenic,  at  least  at  first.  Patients  will  be  met  with  who, 
for  some  mysterious  reason,  do  not  bear  any  of  these  measures 
very  well.  They  seem  to  be  greatly  fatigued  by  them.  In 
such  cases  one  may  have  to  be  content  with  a  general  sponge 
three  times  a  week.  Cases  of  chronic  fatigue  are  poor  subjects, 
just  as  it  would  be  improper  to  give  a  cold  bath  to  a  healthy 
person  greatly  fatigued  by  exercise.  If  such  be  given,  there 
may  be  a  secondary  feeling  of  drowsiness  or  lassitude.  If  any 
hydrotherapeutic  measure  at  moderately  low  temperature  ap- 
plied for  neurasthenia  produces  an  unpleasant  effect,  it  would 
probably  be  corrected  by  raising  the  temperature,  lowering  the 
pressure,  and  shortening  the  bath.  The  types  of  neurasthenia 
are  so  various  and  individual  peculiarities  so  diverse  that  every 
patient  must  be  judged  separately. 

Much  can  be  done  by  way  of  cultivating  the  resistive  powers 
of  these  patients.  A  routine  bath  is  always  to  be  deplored,  but 
especially  here.     Individualization,  education,  and  persistence 


NEURASTHENIA  163 

should  mark  the  treatment  of  these  cases.  Just  as  in  applying 
electricity  to  a  neurasthenic  man  or  woman,  it  is  safer  at  first  to 
apply  the  electrodes  without  current,  so  unusual  care  should  be 
exercised  that  no  shock  be  given  from  the  use  of  either  very  hot 
or  very  cold  water.  Dr.  Baruch  told  the  writer  that  he  con- 
sidered his  principal  contribution  to  the  technic  of  hydrotherapy 
to  be  the  educational  bath.  To  render  this  feasible  by  definite 
gradations  of  pressure,  temperature,  and  duration  he  had  the 
douche  table  constructed  which  is  identified  with  his  name 
(see  p.  282).  In  other  words,  the  successful  treatment  of  these 
cases  depends  on  intelligent  dosage. 

The  most  successful  method  of  treating  neurasthenia  is 
that  which  was  first  formulated  by  Dr.  Weir  Mitchell  forty 
years  ago.  This  celebrated  plan  of  the  "rest  cure"  embraces, 
among  other  physical  methods,  hydrotherapy.  During  the 
earlier  stages  of  treatment  the  drip  sheet  is  usually  suitable  and 
advised  by  Dr.  Mitchell,  the  technic  of  which  is  described  on 
p.  246.  It  has  the  advantage,  in  common  with  the  cold  pack,  of 
being  appHed  while  the  patient  remains  in  bed,  and  does  not 
require  apparatus.  During  the  later  period  of  treatment,  if  the 
patient  is  in  a  hospital  or  sanitarium,  it  is  easy  to  employ  cabinet 
baths  either  by  hot  air  or  electric  hght,  followed  by  the  needle 
(circular)  douche,  jet,  and  Scotch  douches.  Salt  rubs  are  easily 
given  and  may  prove  useful  in  any  stage  of  the  treatment.  Fric- 
tion with  a  dry  towel  after  cold  packs,  sprays,  and  douches  is 
highly  important  to  secure  reaction. 

Neurasthenic  patients  need  the  neurovascular  training  in- 
stituted and  described  by  Dr.  Baruch,  and  it  is  necessary  to  be 
extremely  cautious  in  the  use  of  cold.  By  tact  and  perseverance 
and  the  use  of  mild  measures  at  the  outset  these  highly  sensitive 
subjects  may  be  trained  to  react,  and  wiU  become  interested  in 
the  measures  adopted  and  eventually  recognize  the  good  effect 
to  the  circulation.  Not  the  least  of  all  the  benefits  derived  will 
be  the  cultivation  of  a  healthy  state  of  will  power  and  the  return 
of  hope,  which  is  always  a  very  small  asset  in  the  neurasthenic 
patient.     There  are  various  trying  symptoms  of  neurasthenia 


164  HYDROTHERAPY 

which  demand  special  forms  of  treatment.  The  insomnia  is 
sometimes  relieved  b}^  the  application  of  dry  cold  to  the  spine 
for  an  hour  in  the  evening. 

Douche  or  Control  Table.— In  carrying  out  treatment  with 
the  aid  of  this  a[)paratus  the  author  directs  the  use  of  the  hot- 
air  cabinet  short  of  perspiration;  this  takes  six,  eight,  or 
ten  minutes  at  a  temperature  of  170°  or  180°  F.  (76.7°  or 
82.2°  C).  The  electric-Ught  cabinet  may  be  employed,  as  a 
rule,  in  place  of  the  hot-air  cabinet.  Then  one  or  two  minutes 
in  the  circular  douche,  the  temperature  being  reduced  in  the 
time  allowed  from  105°  to  90°  F.  (40.G°-32.2°  C),  and  the 
pressure  being  15  pounds.  Then  the  jet  douche  for  fifteen  or 
thirty  seconds,  reduced  from  90°  to  75°  F.  (32.2°-23.9°  C),  at 
the  same  pressure;;  followed  by  the  fan  douche  at  the  same 
pressure  and  at  75°  F.  (23.9°  C). 

From  day  to  day  the  temperature  of  the  terminal  douche  is 
reduced  1  or  2  degrees  until  G5°  or  60°  F.  (18.3°  or  15.6°  C.)  is 
reached;  the  pressure  is  raised  to  20  pounds.  The  jet  and  cir- 
cular douches  are  correspondingly  raised  in  pressure.  The  tem- 
perature can  be  lowered  and  the  pressuse  raised  more  rapidly  in 
some  cases,  especially  in  those  in  which  good  reaction  takes 
place  in  the  first  or  second  bath.  As  in  all  other  educational 
processes,  some  subjects  progress  rapidly,  while  others  are  more 
sluggish.  Hence,  the  physician  nuist  be  in  touch  with  the  oper- 
ator, receive  immediate  reports,  or,  better  still,  if  possible,  watch 
the  procedure.  In  Paris  the  author  found  that  the  doctors  in 
charge  of  the  hydrotherapeutic  establishments  gave  all  the 
douches  personally  to  men  and  women  alike.  In  hospitals,  sana- 
toria, and  health  resorts  this  oversight  is  better  systematized 
than  elsewhere  and  often  accounts  for  the  better  results  ol> 
tained.  Some  institutions  and  resorts  in  the  United  States 
provided  with  douche  tables  are  mentioned  on  pp.  284-286. 

Prolonged  hot  baths,  the  hot  spout,  and  hot  packs  are  not 
suitable  measures  in  neurasthenia;  the  ultimate  effect  of  these, 
even  when  followed  by  a  cool  shower  or  douche,  is  bad. 


SPERMATORRHEA  165 

SEXUAL  NEURASTHENIA 

Good  results  follow  cold  bathing  in  the  morning.  The 
patient  is  made  to  stand  in  a  bath-tub  containing  warm  water, 
while  cold  water,  preferably  at  a  temperature  of  55°  to  70°  F. 
(12.8 °-21. 1  °  C),  according  to  the  temperature  of  the  available 
supply,  is  made  to  flow  from  the  occiput  to  the  spine.  Two  or 
three  minutes  at  first  and  later  five  minutes  will  suffice.  The 
patient  should  rub  himself  briskly.  Good  food  with  moderate 
doses  of  strychnin  or  phosphorus  aid  the  treatment.  Local  treat- 
ment of  all  kinds  should  be  avoided. 

SPERMATORRHEA 

Cold  water  ablutions  are  often  advised,  but,  on  account  of  the 
strong  reaction  produced,  are  not  so  beneficial  as  those  with 
lukewarm  water  without  active  rubbing  of  the  body  surface. 
The  skin  may  be  dried  by  merely  applying  the  towel,  or  it  may 
be  allowed  to  dry  spontaneously. 

Impotence,  with  general  muscular  weakness,  loss  of  tone, 
lack  of  general  strength  and  vitality,  accompanied  by  imperfect 
and  rapidly  subsiding  erections,  should  be  treated  with  cold  peri- 
neal douches  having  a  moderate  force  and  for  considerable 
lengths  of  time.     (See  Ascending  Douche,  p.  262.) 

In  applying  cold  water  it  should  be  dashed  or  sopped  against 
the  perineum  or  the  scrotum.  The  scrotum  may  be  submerged 
in  a  tumblerful  of  cold  water  for  one  or  two  minutes  each  night, 
at  the  same  time  applying  cold  to  the  lumbar  region. 

Some  years  ago  Dr.  J.  William  White  advocated  strongly 
the  use  of  the  bidet.^  This  attachment  to  the  bowl  of  the  or- 
dinary water-closet  allows  a  current  of  cold  water  to  be  directed 
gently  upward  against  the  parts.  While  the  principal  is  a  good 
one,  the  arrangement  has  many  objections  and  has  fallen  into 
disuse. 

^  See  Hare's  Therapeutics,  13th  edition,  article  on  Cold. 


166  HYDROTHERAPY 

NEUROSES  OF  THE  BLADDER 

In  enuresis  nocturna  it  is  best  to  try  the  half-bath,  and  later, 
in  older  children,  a  cold  rain  douche.  Affusions  with  water  at 
00°  F.  (15.6°  C.)  may  be  used. 

In  all  neuroses  suggestion  of  cure  by  the  means  employed 
should  not  be  forgotten. 

INSOMNIA 

"Whatever  the  cause  of  insomnia,  whether  due  to  pain,  the 
irritation  of  cough,  to  gastro-intestinal  affections,  to  high 
arterial  tension,  or  to  low  arterial  tension,  there  is  one  condition 
which  is  generally  considered  necessary  to  sleep,  and  that  is  a 
state  of  cortical  anemia.  Hydrotherapeutic  measures  must  be 
chosen  with  this  end  in  view,  and,  fortunately,  most  of  them  are 
applicable.  The  late  Sir  William  Broadbent,  in  a  critical  analy- 
sis of  the  various  cause  of  insomnia,'  discusses  the  influence  of 
high  and  low  arterial  tension.  High  blood-pressure  is  not  by 
any  means  invariably  attended  with  sleeplessness,  but  it  is  a 
contributory  cause  of  the  sleeplessness  of  old  age,  of  arterial  de- 
generation, and  of  renal  disease.  The  blood-pressure  overcomes 
the  resistance  in  the  cerebral  arterioles  and  maintains  an  active 
blood  supply  to  the  cortex  which  is  inconsistent  with  sleep. 
When  no  other  cause  of  habitual  difficulty  and  delay  in  going  to 
sleep  can  be  found  and  the  pulse  tension  is  high,  the  possibility 
that  this  is  a  cause  must  be  entertained. 

Sir  William  Broadbent  remarks  that  "When  cold  feet  in- 
terfere with  sleep,  it  is  not  merely  through  the  feeling  of  cold  as 
such,  but  by  an  influence  on  the  general  and  cerebral  circulation. 
Coldness  of  the  feet,  indeed,  is  often  a  concomitant  of  sleepless- 
ness, rather  than  its  cause,  and  an  incident  of  general  vasomotor 
disturbance,  which  may  be  a  gastro-intestinal  reflex.  When 
the  feet  are  cold  after  hard  brain  work,  the  blood  seems  to  be 
positively  shut  off  from  the  feet.  A  hot  bottle  is  then  often  of 
no  use,  and  the  best  way  of  warming  the  feet  and  procuring 

^  The  Practitioner,  London,  July,  1906. 


INSOMNIA  167 

sleep  is  to  stand  in  cold  water  (preferably  running  water)  and 
then  rub  the  feet  dry  with  a  rough  towel." 

In  the  majority  of  cases  the  warm  bath,  90°  to  98°  F.  (32.2°- 
36.7°  C),  or  the  full  hot  bath,  98°  to  104°  F.  (36.7°-50°  C), 
at  bedtime  may  be  found  successful.  The  author  has  found 
it  necessary  to  prolong  the  duration  of  these  baths  from  ten  to 
thirty  minutes  in  obstinate  cases  and  to  have  them  repeated 
several  times  during  the  night.  The  attendant  should  not  fail 
to  keep  the  turban  wet  with  cool  water,  changing  it  frequently, 
so  as  to  keep  the  head  cool.  The  patient  should  be  rubbed  dry 
quickly  and  put  in  bed.  On  a  succeeding  night  the  wet  pack 
should  be  tried  should  the  treatment  just  detailed  prove  in- 
effectual. Friction  of  the  entire  body  should  be  given  after  the 
pack.  The  drip  sheet  has  also  proved  useful  in  many  cases  (see 
p.  246). 

The  prolonged  tepid  bath,  96°  to  100°  F.  (35.6°-37.8°  C), 
just  before  bedtime  may  also  give  relief.  After  about  fifteen 
minutes  the  patient  is  quickly  dried  without  much  rubbing  and 
given  a  cool  foot  bath,  with  brisk  rubbing  of  the  feet.  The  head 
should  also  be  wet  with  cool  or  cold  water. 

In  cases  attended  with  overactivity  of  the  cerebral  circula- 
tion, the  spinal  douche,  with  brisk  rubbing  of  the  body  and  cold 
applications  to  the  head,  often  aids  other  forms  of  treatment. 
The  object  is  to  secure  cutaneous  hyperemia  without  per- 
spiration. 

Rationale. — ^Primary  effect:  Contraction  of  the  capillaries 
of  the  surface  and  hyperemia  of  the  brain  and  internal  organs. 
Secondary  effect:  Hyperemia  of  the  skin;  depletion  of  the 
brain. 

The  use  of  a  towel  wet  in  cold  water  placed  around  the  neck 
while  the  patient  is  in  bed  may  also  be  successful;  or  the  feet  and 
ankles  may  be  placed  for  fifteen  minutes  in  hot  water. 

Local  packs  to  the  legs  and  to  the  abdomen  may  also  be 
tried  where  tubs  are  not  at  hand.  The  abdominal  pack,  called 
Neptune's  girdle,  is  described  on  p.  356.  In  any  case  it  is  desir- 
able to  make  cold  applications  to  the  head  with  free  use  of  water 


168  HYDROTHERAPY 

on  the  face  and  forehead.  The  sitz-bath,  in  water  at  70°  to  75°  F. 
(21.1°-23.9°  C),  for  ton  to  twenty  minutes,  with  the  feet  and 
legs  well  covered,  is  useful  in  the  insonniia  accompanying  sexual 
neurasthenia,  or  hypersensitive  conditions.  Whether  cold  baths, 
half-baths,  or  sitz-baths  are  used,  it  is  better  not  to  dry  the 
l)aticnt  completely,  but  let  him  quickly  put  on  night  clothing 
and  get  into  bed.  Forchheimer  gives  th(^  preference  to  the  gen- 
eral moist  pack  carefully  applied  and  continued  for  one  to  two 
hours. 

Sea-bathing. — In  suitable  localities  sea-bathing  may  be 
found  very  useful,  but  the  drowsiness 'whicli  follows  prolonged 
sea-bathing  is  undesirable  and  may  be  an  index  of  physical  weak- 
ness. Used  with  judgment,  moderate  sea-bathing  will  favor 
natural  sleep. 

INSANITY 

Currie  used  cold  batlis  in  insanity  in  1796,  and  records  several 
cures  of  maniacal  patients  by  throwing  them  "  headlong  into  the 
cold  bath."i 

The  following  is  from  the  record:  "The  direction  had  been 
followed,  and  on  the  morning  of  the  23d  he  was  again  tin-own  into 
the  cold  bath  in  the  height  of  his  fury,  as  before.  As  he  came  out, 
he  was  thrown  in  again,  and  this  was  repeated  five  different  times, 
till  he  could  not  leave  the  bath  without  assistance.  He  became 
perfectly  calm  and  rational  in  the  bath,  and  has  remained  so 
ever  since.  He  never  relapsed  and  was  discharged  some  time 
afterward,  in  perfect  health  of  body  and  mind." 

Systematic  treatment  of  the  insane  by  means  of  hydrotherapy 
has  been  carried  out  with  considerable  success  in  this  country  at 
the  United  States  Government  Hospital  for  the  Insane,  Washing- 
ton, D.  C;  at  the  Sheppard  and  Enoch  Pratt  Hospital,  Towson, 
Md.;  at  the  Eastern  Maine  Hospital  for  the  Insane,  at  Bangor; 
The  Craig  Colony  for  Epileptics,  at  Sonyea,  N.  Y.;  the  McLean 
Asylum,  Waverly  Mass.;  at  the  Danver's  Asylum,  Mass.;  at  the 
Butler  Hospital  Providence,  R.  I. ;  at  the  Columbus  State  Hos- 

1  Op.  cit.,  pp.  21  and  59. 


INSANITY 


169 


pital,  Columbus,  Ohio;  at  the  Ohio  State  Hospital  for  the  Insane, 
Massilon,  Ohio;  at  the  University  Hospital,  Ann  Arbor;  at  the 
Philadelphia  General  Hospital  (Blockley);  at  the  Pennsylvania 
Hospital  for  the  Insane;  at  the  Morris  Plains  State  Hospital  for 
the  Insane;  at  the  Manhattan  State  Hospital  for  the  Insane, 
Wards  Island,  N.  Y. ;  at  the  J.  Hood  Wright  Hospital,  N.  Y. ;  and 
also  at  various  private  institutions,  such  as  Dr.  Parson's,  at 
Ossining,  N.  Y.,  and  Dr.  Bond's  House  at  Yonkers,  N.  Y. 


Fig.  40. — Continuous  baths,  showing  an  insane  patient  in  the  tub. 
is  assigned  to  two  patients. 


One  attendant 


They  are  all  equipped  with  modern  douche  tables  and  many 
with  continuous  baths.  One  of  the  first  to  report  on  the  results 
of  treatment  was  the  late  Dr.  G.  W.  Foster.  His  report,  pub- 
lished in  1899,^  gives  the  results  of  treatment  in  12  epileptics 
and  21  cases  of  paresis.  The  average  duration  of  treatment  of 
the  epileptics  was  over  seven  months.  In  every  case  but  one 
a  marked  improvement,  both  mental  and  physical,  followed. 
The  average  loss  in  number  of  fits  was  40  per  cent.     The  cases  of 

^  American  Journal  of  Insanity,  vol.  Iv,  No.  4. 


170  HYDROTHERAPY 

general  paralysis  of  the  insane  were  naturally  not  so  satisfac- 
tory, although.  3  were  reported  as  arrested  and  G  improved. 
Of  course,  in  the  absence  of  precise  objective  data  by  which  a 
comparison  may  be  made  of  the  patients'  mental  condition  be- 
fore and  after  treatment,  the  judgment  of  the  medical  attendant 
must  alone  be  relied  upon. 

Dr.  Foster  reported  3  cases  of  acute  mania  recovered;  2  of 
acute  dementia;  1  of  acute  melancholia,  and  1  of  morphinism. 

The  late  Dr.  Dent  also  reported  great  success  in  the  treat- 
ment of  insanity.  The  same  methofls  have  been  continued  by 
Dr.  William  Mabon  in  the  Manhattan  State  Hospital,  New 
York. 

Dr.  B.  R.  Logic  has  continued  this  method  of  treatment 
at  the  United  States  Government  Hospital  for  the  Insane  during 
the  last  six  years,  applying  it  to  all  forms  of  insanity.  In  mania 
with  depression  he  believes  the  disease  has  been  shortened 
and  the  symptoms  modified  from  the  beginning.  Nearly  all 
of  these  cases  have  made  rather  rapid  and  good  recoveries,  pro- 
longed periods  of  excitation  having  been  rare. 

In  a  personal  communication,  dated  February  21,  1905,  Dr. 
Logic  writes:  "In  all  cases  of  excitement  and  depression  I  would 
ofttimes  be  able  to  relieve  the  symptoms.  In  epilepsy  I  believe 
that  during  the  period  of  a(^tivc  treatment  in  a  number  of  in- 
stances the  attacks  were  greatly  reduced  in  number,  and  j)erhaps 
not  so  severe  at  the  time  of  occurrence.  In  the  paretic  and  the 
large  class  of  chronic  insane,  including,  of  course,  the  dementias, 
I  have  been  able,  by  keeping  in  first-class  order  the  physical  con- 
dition, and  by  especially  directed  efforts  toward  such  symptoms 
as  excitement  and  depression,  to  render  the  jiatients  comfortable, 
and  perhaps  to  prolong  their  existence.  Personally,  I  approve 
of  the  treatment,  and  believe  that  it  stands  to-day  without  a 
rival. 

"My  methods  of  applying  the  treatment  are  few,  owing  to 
the  fact  that  experience  has  apparently  demonstrated  that  there 
are  only  a  few  procedures  which  it  is  really  worth  while  to  use. 
As  a  matter  of  routine,  then,  I  have  adopted  these,  and,  altering 


INSANITY  171 

them  to  suit  any  case,  have  confined  myself  almost  exclusively 
to  their  use.  The  most  prominent  of  these  procedures  is  as  fol- 
lows :  First,  the  cold  wet  pack ;  second,  the  hot-air  box.  After 
each  I  am  in  the  habit  of  dressing  the  patient  either  by  cold 
towels  or,  preferably,  the  Scotch  douche.  In  cases  that  are 
very  much  excited  I  use,  as  a  rule,  a  warm  bath,  temperature 
about  112°  F.  (44.4°  C),  followed  by  a  prolonged  submersion 
in  the  neutral  bath."  The  author  does  not  advise  so  hot  a 
bath. 

The  author  would  advise  in  all  cases  of  moderate  excitement 
a  hot  wet  pack  as  a  sedative.  A  blanket  is  laid  on  the  bed  and 
a  linen  sheet  wrung  out  of  hob  water  is  quickh^  spread  over  the 
blanket.  The  patient,  whose  clothes  have  been  removed,  is 
then  laid  upon  the  sheet,  which  is  folded  about  him  and  then 
enveloped  in  the  blanket.  A  cold  compress  should  be  applied 
to  the  head.  The  result  is  a  relaxing  neutral  pack  when  the 
temperature  of  the  skin  and  sheet  are  equalized. 

The  hammock  has  been  utilized  to  hold  very  violent  patients 
in  the  continuous  bath,  using  water  at  100°  F.  (37.8°  C),  with  a 
remarkable  sedative  effect.  This  is  the  best  tranquillizing  pro- 
cedure when  prolonged. 

The  tubs  used  for  the  continuous  baths  in  the  Manhattan 
State  Hospital  are  large  and  deep,  with  rolling  edges,  and  under 
the  edges  are  hooks  for  the  attachment  of  a  canvas  hammock 
upon  which  the  patient  lies.  There  is  an  inlet  at  the  head  of 
the  tub  into  which  the  water  runs  continuously  while  the  tub 
is  in  use,  and  three  outlets  at  the  foot,  one  near  the  top  which 
prevents  overflow,  one  at  the  bottom,  and  one  near  the  middle 
with  a  large  stopper,  by  which  the  tub  can  be  emptied  of  all 
excreta.  The  flow  of  the  water  and  its  temperature  are  controlled 
entirely  from  the  table,  and  in  addition  to  this,  in  order  that  all 
possible  danger  of  mistake  may  be  avoided,  a  bath  thermometer 
is  kept  in  the  tub  tied  to  its  edge.  The  thermometer  in  the  tub 
registers  a  slightly  lower  temperature  than  that  shown  on  the 
control  table,  the  difference  varying  from  1  to  3  degrees,  accord- 
ing to  the  apparatus. 


172  HYDROTHERAPY 

The  patients  treated  by  these  baths  are  restless,  delirious,  and 
violently  disturbed  cases.  They  are  kept  in  the  tub  usually  for 
the  entire  twenty-four  hours  without  removal  except  for  cleaning 
the  tubs,  and  for  a  sufficiently  long  period  to  allay  their  excite- 
ment, varying  from  a  day  to  two  or  three  months. 

The  following  is  the  routine  procedure  of  preparing  the  tubs 
for  and  placing  the  ])atient  therein: 

In  the  first  place  the  tubs  are  drawn  half-full  of  water,  the 
hammock  placed  in  position,  and  the  patient,  wearing  a  chemise, 
placed  on  the  hannnock ;  across  the  whole  length  of  the  tub  are 
stretched  sheets  tied  at  each  side,  thus  entirely  covering  the 
patient  except  her  head,  which  rests  upon  a  rubber  air-cushion. 
If  the  patient  is  very  disturbed  and  assaultive,  it  may  be  necessary 
to  wrap  her  in  sheets  secured  with  safety-pins  until  she  become 
quiet.  The  water  is  kept  at  a  temperature  of  from  98°  to  100°  F. 
(36.6°-37.7°  C.)  except  in  very  hot  weather,  when  it  is  some- 
times allowed  to  drop  to  95°  F.  (35°  C).  Every  morning  the 
patient  is  removed  for  an  hour  while  the  tub  and  the  hammock 
are  cleaned  and  the  patient's  entire  body  anointed  with  some 
bland  ointment  to  prevent  irritation  from  the  continuous  appli- 
cation of  the  water. 

A  nurse  in  charge  of  the  bath-room  is  on  duty  eight  hours; 
her  duties  are  to  watch  the  temperature  of  the  water,  attend  to 
the  ventilation  and  keep  the  patients  as  quiet  as  possible,  take 
their  temperature  twice  a  day  or  oftener  if  ordered,  and  feed 
them  unless  they  are  able  to  feed  themselves.  Each  nurse,  as 
a  rule,  has  two  patients.  There  are  ten  such  tubs  in  all  through- 
out the  hospital.     (See  also  pp.  287-291.) 

MELANCHOLIA 

In  the  incipient  stage  prolonged  warm  baths  are  useful,  but 
should  not  be  continued  to  the  point  of  marked  muscular  de- 
bility. A  change  should  be  soon  made  to  the  more  tonic  form 
of  treatment  by  the  hot-air  cabinet,  circular,  jet,  Scotch  and  fan 
douches,  follow^ed  by  alcohol  rubbing.  A  good  prescrii)tion  for 
fairly  robust  cases  would  be  as  follows : 


EXCITED    STATES  173 

Electric-light  or  hot-air  cabinet,  eight  to  ten  minutes,  or  to  perspiration. 

Circular  douche,  two  minutes,  105°  to  90°  F.  (40.6°-32.2°  C),  20  pounds. 

Jet  douche,  one  minute,  100°  to  80°  F.  (37.8°-26.7°  C),  15  to  20  pomids. 

Scotch  douche,  twenty  seconds,  105°  to  80°  F.  (,40.6°-26.7°  C),  15  to  20 
pounds. 

Fan  douche,  ten  seconds,  78°  F.  (16.7°  C),  20  poimds. 

Dry  with  friction  and  follow  with  an  alcohol  rub.  Reduce  minima  1  de- 
gree daily  until  60°  F.  (15.6°  C.)  is  reached. 

The  Scotch  douche  may  be  omitted  at  the  commencement 
of  treatment  in  most  cases. 

Artificial  Nauheim  Baths. — The  author  would  call  attention 
to  the  excellent  effect  of  the  artificial  Nauheim  baths  in  all  men- 
tal cases.  He  has  had  excellent  results  in  their  use.  They  are 
easily  given  in  the  home  or  hospital  where  the  more  elaborate 
apparatus  is  lacking,  and  it  is  usually  agreeable  and  interesting 
to  the  patient  (see  p.  311). 

Oxygen  baths  are  Hkewise  suitable  for  these  cases. 

EXCITED   STATES 

The  continuous  bath  has  been  inti'oduccd  comparatively 
recently  into  American  hospitals  for  the  insane,  although  for  over 
twenty  years  it  has  been  used  in  England  and  on  the  continent. 
The  experience  at  Bethlehem  (Bedlam)  and  Prof.  Kraepelin's 
clinic  has  been  uniformly  satisfactory  in  excited  states.  In 
April,  1907,  eight  continuous  baths  were  instilled  in  the  Phila- 
delphia Hospital  for  the  Insane  (Blockley).  Since  that  time 
the  patients  treated  in  this  manner  included  cases  of  acute, 
chronic,  and  recurrent  mania;  excited  types  of  dementia  pri3ecox; 
maniacal  episodes  of  epilepsy;  dementia  paralytica  and  senile 
dementia;  alcohoUc  insanity,  and  insanity  of  chorea.  The  chief 
resident  physician,  Dr.  W.  W.  Hawke,  and  the  assistant  phys- 
ician. Dr.  Walter  G.  Bowers,  report  great  improvement,  especially 
in  the  cases  of  mania,  excited  cases  of  dementia  prsecox,  senile 
dementia,  and  toxic  cases,  including  insanity  of  chorea.  Dr. 
Bowers  furnishes  the  following  notes : 

''  Case  1. — Daniel  D.,  aged  thirty,  white  (acute  mania).  On 
admission,  this  patient  was  garrulous,  vituperative,  restless, 


174  HYDROTHERAPY 

noisy,  and  hostile  in  manner.  He  was  placed  in  the  contin- 
uous bath  Oct.  IG,  1907.  The  temperature  of  the  water  was 
100°  F.  (37.8°  C).  Little  or  no  improvement  was  noted  at  the 
end  of  the  first  day.  On  the  second  day  the  temperature  of 
the  water  was  raised  to  105°  F.  (40.6°  C).  The  patient  began 
to  show  improvement,  which  gradually  continued,  and  at  the 
end  of  the  fifth  day  motor  restlessness  ceased  and  the  patient 
was  no  longer  garrulous  and  noisy.  In  this  case  a  permanent 
benefit  was  observed  and  the  patient  was  discharged  a  few 
weeks  later,  restored. 

"  Case  2. — P'rank  D.,  aged  fifty-five,  white  (toxic  insanity,  al- 
coholic confusional),  noisy  and  restless,  fearing  that  he  was  about 
to  be  killed.  The  patient  was  placed  in  the  bath  June  19,  1907, 
at  5  p.  M.  The  temperature  of  the  water  was  100°  F.  (37.8°  C). 
The  patient  gradually  became  quiet,  and  at  the  end  of  the  third 
day  was  no  longer  fearful  or  agitated. 

"Case  3. — John  P.  R.,  aged  eighteen,  white  (insanity  of 
chorea) .  The  patient  was  restless,  with  general  choreiform  move- 
ments. He  was  placed  in  the  bath  June  20,  1907,  at  11a.  m. 
The  temperature  of  the  water  was  95°  F.  (35°  C).  At  the  end 
of  three  days  movements  became  decidedly  less  in  number  and 
extent. 

"  No  restraint  is  used  while  patients  are  in  the  bath.  They 
are  allowed  house  diet,  with  milk  and  eggs  between  meals, 
and  careful  attention  is  paid  to  the  emunctories.  Sedatives 
and  all  forms  of  internal  medication  are  removed  while  the 
patient  is  in  the  bath,  save  on  occasional  indication  for  diffusible 
stimulants.  Despite  careful  padding  of  tubs,  a  few  patients 
developed  superficial  excoriations  over  the  regions  of  the  scapulae, 
shoulders,  buttocks,  and  elbows.  Others  complained  of  tender 
palms  and  soles,  only,  however,  after  being  in  the  tub  several 
days.  One  case  of  acute  eczema,  involving  thighs,  legs,  and  feet, 
which  was  somewhat  refractory  to  treatment,  developed  in  a 
colored  patient  after  he  had  remained  in  the  bath  five  days. 

"  In  two  other  cases  a  skin  rash,  resembling  impetigo,  devel- 
oped, which  was  transient  in  character.    We  have  also  treated 


EXCITED   STATES  175 

patients  with  ichthyosis  and  psoriasis  with  at  least  temporary 
benefit. 

"  The  same  care  used  in  selecting  patients  for  the  continuous 
flowing  bath  was  used  in  selecting  patients  for  treatment  in  the 
douche  room  and  hot-air  cabinets,  as  little  save  the  detergent  and 
slightly  stimulating  effect  of  the  baths  can  be  expected  from 
hydrotherapy  in  the  treatment  of  chronic  insane.  Excellent 
results  were  obtained  by  the  use  of  hot-air  cabinets  in  toxic 
cases,  especially  the  acute  alcoholic  insanities,  also  cases  of  mania 
and  uremia;  patients  in  such  cases  were  kept  in  the  cabinet  until 
a  profuse  sweat  was  produced.  While  in  the  cabinet  the  patients 
drank  freely  of  water.  They  were  then  given  a  spray  and  rain 
bath  for  three  minutes  at  95°  F.  (35°  C),  the  temperature  being 
gradually  reduced  to  80  °  F.  (26.7  °  C.) ,  save  in  the  cases  of  uremia, 
in  which  the  patients  were  given  a  sponge  bath  after  sweating 
profusely. 

"  A  number  of  dementia  praecox  patients  in  a  dull,  stupid, 
and  apathetic  state,  also  a  few  patients  with  melancholia  and 
neurasthenia,  showed  considerable  improvement  both  physically 
and  mentally  after  use  of  the  spray  and  rain  bath  at  90°  F.  (32.2° 
C.)  for  three  minutes,  followed  by  the  Scotch  douche,  moderate 
to  full  force  at  90°  F.  (32.2°  C),  gradually  reduced  to  75°  F. 
(23.9°  C),  for  two  minutes,  the  douche  being  played  rapidly  up 
and  down  the  entire  length  of  the  spinal  column. 

"  Patients  with  saturnism,  with  the  associated  paralysis,  also 
the  polyneuritis  of  alcohol,  with  and  without  Korsakow's  psy- 
chosis, showed  marked  improvement  and  recovery  by  the  use  of 
the  hot-air  treatment  and  immersion  bath,  the  patient  remain- 
ing in  the  tub  thirty  minutes  and  being  urged  to  exercise  while  in 
the  water. 

"  Painful  and  inflammatory  hemorrhoids  were  treated  daily 
with  the  perineal  douche ;  as  a  result,  the  hemorrhoids  shriveled 
up  and  ceased  to  be  painful  and  inflammatory.  It  is  recognized 
that  constipation  is  habitual  in  the  insane.  Favorable  results 
were  obtained  by  the  use  of  the  sitz-bath  and  liver  spray  daily  at 
a  temperature  of  100°  or  105°  F.  (37.8°  or  40.6°  C). 


176  HYDHOTHEHAPY 

''  For  the  (lotoro;ont  offcct,  from  10  to  20  pationts  were  sent 
from  the  ward  daily  to  receive  a  rain  and  spray  bath.  Four 
thousand  such  baths  have  been  given  during  the  past  year."' 

Baker-  reports  the  emijloyment  of  hyth'Otherapv  in  26  cases 
of  melancliolia,  with  or  without  agitation,  dementia  pru'cox, 
hysteria,  puerperal  insanity  characterized  by  slowness  of  thought, 
painful  delusions,  etc.,  cases  showing  lack  of  nervous  and  mus- 
cular tone,  sluggish  circulation,  loss  of  weight,  greasy  and  acne- 
covered  skin,  intestinal  fermentation,  and  other  complications. 
The  baths  in  these  cases  are  used  for  various  pericxls,  depending, 
of  course,  on  the  case.  He  rei)orts  decidedly  good  results,  such 
as  quieting  of  agitation,  gradual  disappearance  of  delusions,  and 
physical  improvement. 

Warm  baths  or  the  modified  continuous  baths  m^y  be  more 
conveniently  used  by  day.  They  should  last  for  from  twelve 
to  fourteen  hours.  Dr.  Stockton,  in  speaking  of  his  experience, 
says  that  the  patients  not  only  improved,  gained  in  weight,  slept 
better,  and  became  quieter,  but  that  they  were  also  able  to  dis- 
pense with  the  use  of  drugs. 

Water  at  the  proper  temperature  and  adapted  to  the  intli vid- 
ua), adds  to  the  nervous  energy,  stimulates  the  functions  of  the 
body,  and  improves  the  resisting  power  against  disease.  The 
kidneys  act  more  vigorously,  the  fact  that  the  urine  is  found  to 
be  more  toxic  after  a  bath  being  abundant  proof  that  baths  assist 
in  the  elimination  of  poisonous  material.  It  stimulates  respira- 
tion and  so  eliminates  poisonous  matter.  The  use  of  baths  in  no 
way  interferes  with  the  medical  treatment  of  patients,  and,  in- 
deed, properly  administered,  they  largely  increase  the  efficiency 
of  many  drugs  and  do  not  interfere  with  any.  The  warm  bath 
renders  the  surface  of  the  body  less  sensitive,  numbs  the  terminal 
nerve-fibers,  and  produces  a  sedative  action.  Whenever  there 
is  delirium,  restlessness,  or  insomnia,  the  neutral  bath  is  in- 
dicated. 

1  Jour.  Amer.  Med.  Assoc,  Oct.  24,  19C8. 

^  Medical  Record,  Oct.  10,  1908,  article  by  Dr.  George  Stockton,  Columbus 
State  Hospital  for  the  Insane,  Ohio. 


EXCITED    STATES  177 

Removing  Patient  from  Bath  to  Bed. — ^Whenever  the 
patient  is  to  be  removed  from  the  continuous  bath  to  Ms  bed,  as, 
for  instance,  toward  night,  when  the  treatment  is  not  deemed 
necessary  in  milder  cases,  it  is  highly  desirable  to  avoid  all 
chilling  from  the  ordinary  atmospheric  temperature  of  the  room. 
A  hot  dry  sheet  should  be  at  hand  to  envelop  the  patient.  He 
is  then  put  in  a  warmed  bed  and  night  clothes  adjusted.  This 
will  avoid  any  check  to  the  surface  blood  and  in  a  measure  main- 
tain a  good  superficial  circulation.  A  steam-heated  hot  closet 
should  be  provided  in  planning  tlie  hydrotherapeutic  department 
of  any  institution,  so  that  these  hot  sheets  may  always  be  at  hand 
when  patients  leave  the  bath,  whether  of  the  continuous  type  or 
after  the  routine  application  of  douches.  If  this  be  not  properly 
installed,  the  only  recourse  is  to  keep  the  sheets  piled  over  some 
convenient  steam  radiator,  although  this  detracts  from  the  gen- 
eral appearance  of  the  room. 

Daily  Routine  Bath. — Those  who  have  much  to  do  with  the 
insane  usually  speak  highly  of  the  continuous  bath,  the  cold  wet 
sheet  pack,  the  electric-light  and  steam-heated  hot-air  bath,  the 
circular  (needle)  douche,  jet,  Scotch,  and  fan  douches. 

In  some  of  the  more  modern  institutions  the  patients  are 
formed  in  line  and  stand  under  large  overhead  showers  (descend- 
ing or  rain  douche).  The  douche  room  should  be  provided  with 
tubular  brass  raihngs  to  keep  the  line  in  order  and  to  give  support 
for  the  hands  of  patients  who  feel  the  need  of  it.  This  daily 
routine  bath  with  suitable  appliances  has  a  wholesome  effect  on 
a  large  class  of  mental  cases,  and  it  can  be  given  to  large  numbers 
daily  with  very  few  attendants.  Excited  cases  should  be  treated 
by  other  methods,  but  in  time  these  patients  may  improve  to  such 
an  extent  as  to  take  the  daily  bath.  The  temperature  is  usually 
reduced  from  100°  to  90°  or  80°  F.  (37.8°-32.2°  or  26.7°  C), 
according  to  the  judgment  of  the  attending  physician. 

General  Instructions. — On  admission  to  hospitals  for  the 
insane  the  condition  of  the  patient's  skin  is  usually  bad.  This 
is  almost  invariably  the  case  am.ong  the  poor,  and  hence  much  can 
be  expected  from  hydrotherapy.     Vitality  is  generally  low,  how- 

12 


178  HYDROTHERAPY 

ever  strong  the  patient  may  appear.  All  demented  and  melan- 
cholic paticnits  are  more  or  less  under  the  influence  of  an  auto-in- 
toxication, and  hence  hydrotherapeutic  measures  and  intestinal 
irrigation  arc  called  for.  Care,  however,  should  always  be  taken 
that  in  using  the  cabinets,  etc.,  no  hot  pipes  or  unguarded  elec- 
tric lights  can  by  any  possibility  be  touched.  The  least  chance 
of  drowning  should  also  be  guarded  against.  It  must  be  remem- 
bered that  an  insane  patient  may  drink  the  water  in  the  tub, 
tamper  with  the  fixtures,  or  break  the  glass  of  apparatus  in  the 
most  unexpected  manner. 

EPILEPSY 

The  position  of  hydrotherapy  in  the  treatment  of  epilepsy 
may  be  considered  as  a  means  of  cure;  an  auxiliary  method 
of  treatment;  a  method  of  making  it  possible  to  administer  con- 
siderably larger  doses  of  bromids  than  usual;  a  method  render- 
ing it  possible  to  reduce  the  dose  of  bromid  to  a  minimum; 
and,  finally,  as  an  excellent  hygienic  measure  favoring  the  action 
of  the  skin,  improving  the  general  tone,  and  favoring  the  oxida- 
tion and  elimination  of  all  toxic  products. 

As  a  cure  per  se  hydrotherapy  is  probably  like  all  other 
medicines — it  has  been  tried  and  found  wanting.  Notwith- 
standing the  fact  that  the  means  employed  consist  of  water, 
cold,  warm,  or  hot,  in  tubs,  douches,  sprays,  vapor  baths,  hot-air 
baths,  and  compresses,  a  method  permitting  the  widest  varia- 
tions in  the  form  of  treatment,  it  probably  has  rarely,  if  ever, 
cured,  in  and  of  itself,  a  case  of  genuine  epilepsy.  Cases  have 
been  reported  cured,  as  is  so  frequently  done  after  surgical  meth- 
ods such  as  trephining,  but  further  investigation  shows  that 
there  has  been  some  error  in  diagnosis,  the  case  being  one  of  hys- 
teria, or  that  relapses  have  occurred. 

A  few  French  authors  have  advocated  hydrotherapy  since 
Fleury,  in  1875,  published  his  treatise  ^  on  the  subject.  Winter- 
nitz  and  his  school  have  declared  that  hydrotherapy  in  epilepsy 

^  Traite  therapeutique  et  critique  d'hydroth^rapie,  Paris,  1875;  also  P. 
Bricon,  Thesis,  1881,  from  Bournonville's  service  at  Bicetre. 


EPILEPSY  179 

employed  exclusively  produces  no  effect.  On  the  other  hand, 
some  of  the  more  recent  German  pubHcations  look  on  the  sub- 
ject more  favorably.  Schweinburg,  in  his  work/  cites  a  patient, 
a  college  student,  who  took,  under  his  direction,  half-baths  for 
a  year,  and  later  entered  official  life  and  has  remained  well  for 
sixteen  years.  Schweinburg  says  that  this  is  not  the  only  sim- 
ilar case  in  his  experience,  but,  of  course,  he  pays  very  strict 
attention  to  the  diet,  and  he  notes  that  when  the  epileptic  is 
ordered  a  combination  of  hydrotherapy  with  a  rigid  dietary  the 
epileptic  attacks  diminish  with  very  little  bromid,  so  that  there 
is  a  reduction  from  6  to  8  gm.  daily  to  1  or  2  gm.  Long  inter- 
vals free  from  attacks  are  obtained  and  a  general  improvement 
in  the  mental  and  physical  condition  is  noted. 

The  procedure  adopted  at  first  was  the  half-bath  at  81.5°  to 
86°  F.  (27.5°-30°  C),  with  affusions  and  strong  rubbing  for 
five  or  six  minutes  once  or  twice  daily.  Before  applying  water 
of  lower  temperature  or  more  energetic  measures,  such  as 
douches,  slapping,  or  in  using  the  high  temperatures,  there  should 
be  caution,  for  attacks  have  occurred  during  the  application  of 
extreme  temperatures.^  Wet  packs,  foot-baths,  and  cold  com- 
presses to  the  head  are  useful  after  severe  attacks.  No  un- 
pleasant results  have  been  noted,  no  increase  in  the  number  of 
attacks,  even  in  the  most  unfavorable  cases.  Schweinburg  con- 
siders the  combined  hydrotherapeutic  and  dietetic  method  more 
as  a  school  for  patients,  who  thus  learn  the  principles  and  prac- 
tice of  hygienic  treatment  to  be  followed  during  the  coming  j^ears. 

Pick  maintains  much  the  same  position  in  holding  that  with 
hydrotherapy  we  can  employ  considerably  smaller  doses  of  the 
bromid  than  when  the  latter  is  given  alone.  He  employs  dur- 
ing the  interval  between  the  attacks  the  so-called  half-baths 
at  80.5°  to  86°  F.  (26.9°-30°  C),  and  of  eight  to  fifteen  min- 
utes' duration,  as  well  as  sitz-baths  and  trunk  compresses  or 
the  so-called  Neptune's  girdle.     Without  necessarily  expecting 

^  Handbuch  der  allgemeinen  iind  Speziellen  Hydrotherapie,  Wiesbaden, 
1904. 

2  Binswanger,  Nothnagel's  Speziellen  Pathologie,  Breitung,  Deutsch.  Med. 
Woch.,  1898,  No.  39. 


180  HYDROTHERAPY 

a  cure,  he  uses  systematic  h3'(lrotherapy  so  as  to  promote  the 
action  of  the  skin  or  as  a  mode  of  treatment  auxiliary  to  other 
measures. 

Binswanger  advises  in  this  connection  a  mild  hydrotherapy 
as  usually  adopted  in  the  general  treatment  of  neurasthenia; 
also  a  daily  bath,  using  water  gradually  cooled  to  r>9°  F.  (15°  C.) ; 
indifferent  baths  two  or  three  timers  a  week  with  or  without  the 
addition  of  salt  or  affusions  at  ()8°  F.  (20°  C).  For  young  and 
vigorous  subjects  he  advises  cool  or  cold  baths  of  only  a  few  min- 
utes' duration.  The  temperature  should  be  about  7o°  F.  (23.9° 
C),  and  gradually  cooled,  according  to  the  state  of  health  of 
the  patient,  to  08°  F.  (20°  C).  He  employs  these  cool  baths 
especially  during  the  first  weeks  of  the  use  of  Flechsig's 
treatment. 

Eulenberg  recognizes  in  such  measures  a  wide  applicability 
to  raising  nutrition  and  improving  the  skin,  almost  never  dis- 
appointing, especially  in  bad  cases  of  bromism.  He  uses  the 
spinal  ice-bag  when  the  mc^thods  referred  to  are  not  permissible. 

Matthes,^  of  Jena,  takes  a  very  conservative  position,  making 
use  of  hydrotherapy  only  for  a  good  effect  on  the  skin  and  an 
increase  of  the  bodily  vigor.  This  is  especially  necessary  during 
treatment  with  bromids  and  should  be  adopted  so  as  to  obviate 
as  much  as  possible  bromid  acne.  He  uses  indifferent  baths,  that 
is,  at  about  the  body  temperature,  three  times  a  week,  and  also 
the  more  refreshing  procedures,  such  as  the  wet  sheet  tub  (ab- 
reibung)  and  half-baths.  During  the  attack  treatment  with 
ice-caps,  stimulating  compresses,  or  diverting  methods,  such  as 
slapping  the  feet  with  cold  cloths,  are  useless.  He  holds  that 
the  action  of  hydrotherapy  in  epilepsy,  whether  for  preventing 
attacks  or  rendering  them  less  frequent,  rests  on  a  very  slender 
foundation. 

As  we  all  know,  bromids  often  do  harm  in  the  treatment 
of  epilepsy.  In  any  large  institution,  such  as  Sonyea,  where 
2000  cases  have  been  treated  and  carefully  studied,  this  diffi- 
culty is  well  recognized,  and  the  average  dose  employed  is  about 
^  Max  Matthes,  Lehrbuch  der  klin.  Hydrotherapie,  Jena,  second  ed.,  1904. 


EPILEPSY  181 

1  gm.  daily.  At  Bielefeld  the  dose  is  about  3  gm.  daily.  In 
France  rather  larger  doses  are  given;  Fere  and  Jarnot  have 
used  from  12  to  16  gm.  daily  in  special  cases. 

Among  the  earlier  symptoms  are  acne  and  physical  depres- 
sion; later,  a  decidedly  weakened  action  of  the  heart,  amounting 
to  chronic  cardiac  asthenia ;  ptosis  of  the  lids  and  even  inability 
to  walk.  In  extreme  cases,  in  which  the  dose  is  very  large  or  the 
patient  unusually  impressed  by  the  drug,  there  may  be  dis- 
turbances of  memory  and  suicidal  or  homicidal  tendencies. 
I  have  seen  an  epileptic  patient  in  an  outburst  of  passion  at  a 
fancied  wrong  attack  a  resident  physician  with  great  violence. 
Such  cases  have  been  recorded  by  Echeverria/  Weir  Mitchell, 
and  others. 

We  would,  therefore,  welcome  any  method  that  will  enable 
us  to  use  these  larger  doses  with  safety  to  the  skin  and  to  the 
mental  equilibrium.  Just  as  warm  baths"  and  other  hydro- 
therapeutic  procedures  undoubtedly  enable  us  to  administer 
potassium  iodid  in  large  doses  with  safety  and  increased  efficacy, 
so  I  believe  that  with  the  help  of  baths  the  bromids  will  be 
better  borne.  Wet  packs  moderate  or  prevent  bromid  acne 
and  help  eliminate  the  bromin  and  toxins.  If  followed  by 
affusions  of  water  at  60°  F.  (15.5°  C.)  the  patient  is  invigorated. 

As  to  any  ill  effects  from  the  use  of  baths,  I  have  knowledge 
of  only  two  instances  in  which  an  attack  occurred  while  bath- 
ing. One  was  in  the  case  of  a  young  man  who  for  nearly  a 
fortnight  had  been  swimming  and  diving  in  a  large  enclosed 
swimming  pool.  Although  in  water  beyond  his  depth,  he  had 
his  convulsion  at  the  surface  and  was  soon  brought  by  friends 
to  a  place  of  safety.  The  temperature  of  the  water  was  about 
78°  F.  (25.6°  C),  and  there  is  no  reason  to  believe  that  the 
water  had  any  special  influence  in  causing  the  attack.  The 
second  case  was  that  of  the  unfortunate  daughter  of  the  late 
Mr.  Samuel  L.  Clemens,  whose  death  by  drowning  in  her  bath 
during  an  epileptic  attack  was  recently  reported. 

In  America  attention  was  first  called  to  the  value  of  hydro- 

^  Manuel  Gonzales  Echeverria,  Amer.  Jour.  Insanity,  1873-74,  vol.  xxx. 


182  HYDROTHERAPY 

therapy  in  epilepsy  by  Dr.  Simon  Baruch,  and  later  by  the  late 
Dr.  G.  W.  Foster,  one  of  the  physicians  at  the  Government  Hos- 
pital for  the  Insane  at  ^^'ashington.^  The  measures  employed 
were  the  drip  sheet,  wet  packs,  and  douches.  By  these  means 
bromid  acne  was  either  prevented  or  relieved  and  the  general 
tone  of  the  patients  was  improved.  The  number  of  attacks  in 
12  patients  was  reduced  by  about  40  per  cent.  Since  this 
report  was  issued  no  further  records  have  been  kept,  and  I  am 
informed  that  few  patients,  if  any,  received  any  permanent  bene- 
fit, and  this  treatment  is  not  now  used  to  any  extent  in  this  class 
of  cases. 

At  the  Pennsylvania  Epileptic  Hosi^ital  and  Colony  Farm  the 
patients  receive  daily  showers  and  a  tepid  tub-bath  once  or  twice 
a  week.  These  are  more  for  hygienic  than  for  therapeutic 
purposes. 

At  the  Glenmary  Sanitarium  at  Owego,  New  York,  baths  are 
given  only  for  personal  cleanliness. 

At  the  Craig  Colony  for  Epileptics  at  Sonyea,  New  York, 
where  complete  hydrotherapeutic  apparatus  is  installed,  sys- 
tematic treatment  is  given  under  the  most  favorable  circum- 
stances, as  these  patients  receive  a  minimum  dose  of  bromid, 
about  1  gm.  daily,  and  are  under  an  excellent  hygienic  regime. 

At  the  Glcnwood  Sanitarium  at  Dansville,  New  York,  Dr. 
J.  W.  Wherry  writes  me  that  some  years  ago  he  gave  considerable 
attention  to  hydrotherapeutic  methods  in  the  treatment  of 
epilepsy,  but  he  is  not  able  to  say  that  he  noticed  any  direct  effect 
on  the  epileptic  condition.  Since  then  he  has  discarded  the 
measure  excepting  when  indicated  on  general  principles  without 
reference  to  the  epileptic  condition  itself.  In  a  letter  to  me  Dr. 
Wherry  remarks  very  truly:  "Whatever  benefits  the  individual 
is  an  aid  in  the  treatment  of  epilepsy.  Some  epileptics,  like 
some  other  people,  would  be  benefited  by  the  employment  of 
hydrotherapy;  others  would  not." 

In  private  practice  difficulties  are  encountered  in  carrying 

1  Report  of  the  U.  S.  Government  Hospital  for  the  Insane,  1898;  also 
Amer.  Jour.  Insanity,  No.  4,  1899. 


HEADACHE  183 

on  systematic  treatment  of  this  description.  Daily  treatment 
for  several  months  would  be  required,  and,  of  course,  unbounded 
patience  and  hope  are  demanded  of  both  physician  and  patient. 
The  usual  experience  of  outdoor  clinics  is  that  as  patients  im- 
prove, their  visits  are  more  infrequent,  but  not  rarely  we  find 
faithful  ones  who  report  regularly  for  years. 

We  would  naturally  expect  that  in  focal  or  traumatic  epilepsy 
less  advantage  would  be  derived  than  in  cases  of  so-called  idio- 
pathic epilepsy,  alcoholic  epilepsy,  psychic  epilepsy,  or  in  cases 
arising  from  intestinal  intoxication  or  obscure  metabolic  changes. 
In  such  cases  the  free  use  of  water  inside  and  out  ought  certainly 
to  be  given  a  prominent  place  in  any  plan  of  treatment  that  may 
be  adopted.^ 

HEADACHE 

In  those  cases  for  which  no  assignable  cause  is  discovered, 
hydrotherapy  is  valuable  in  its  power  to  divert  blood  from  the 
central  nervous  system  to  the  periphery.  Various  means  are 
employed,  the  more  common  being  the  hot  foot-bath  or  the  cold 
foot-bath,  followed  by  vigorous  rubbing.  The  hot  foot-bath  may 
be  given  with  water  at  95°  to  110°  F.  (35°-43.3°  C.)  for  from 
eight  to  ten  minutes.  The  cold  foot-bath,  45°  to  55°  F.  (7.2°- 
12.8°  C),  should  be  shorter;  one  to  two  minutes  at  first  will  be 
sufficient.  If  flowing  water  be  used  the  results  will  be  more 
satisfactory. 

If  foot-baths  are  not  available,  cold  compresses  to  the  head 
ma}^  be  employed.  Vinegar  should  be  added  to  the  band  across 
the  forehead,  and  the  compresses  changed  frec^uently.  Short 
douches  of  hot  or  cold  water  to  the  upper  spine  for  a  fraction  of 
a  minute  are  also  valuable.  Colonic  irrigations  two  or  three 
times  a  week  with  normal  salt  solution  after  an  evacuation  of 
the  bowels  is  advised.  The  Plombieres  douche  or  the  douches 
employed  at  Chatel-Guyon  help  these  cases. 

In  some  severe  cases  of  headache  due  to  brain  tumor  relief 
may  be  afforded  by  hot  mustard  foot-baths  or  other  derivative 

1  Schirbach,  Jour.  Nerv.  and  Ment.  Dis.,  May,  1907. 


184  HYDROTHERAPY 

hot  applications,  such  as  hot  spinal  compresses  or  fomentations. 
The  marked  relief  which  follows  in  some  cases  of  cerebral 
growth  is  of  some  diagnostic  value.  It  is  observed  that  a 
glioma  is  more  amenable  to  relief  than  a  sarcoma  or  gumma. 

THE  NEURALGIAS 

TRIFACIAL  AND  OCCIPITAL  NEURALGIA 

Neuralgia  of  the  fifth  nerve  and  ()('('ij)ital  iieui-al<ria  arc  bene- 
fited by  warm  baths.  It  is  well  known  that  neuialgias  are  less 
severe  in  dry  and  warm  weather,  and  this  points  to  the  use  of  hot- 
air  and  warm  baths  in  connection  with  favoring  climates.  Such 
cases  can  no  doubt  be  more  successfully  treated  in  Egypt,  Sicily, 
and  the  Riviera  or  at  the  Southern  American  water-cure  estab- 
lishments.  The  relation  of  chronic  constipation  to  neuralgia 
should  not  be  overlooked,  and  hence  the  use  of  ))urgatives  wat(TS 
like  those  of  Saratoga,  Crab  Orchard,  French  Lick  (Pluto), 
Apenta,  Hunyadi,  Paibinat,  and  other  well-known  aperients. 

SCIATICA 

In  sciatica  both  heat  and  cold  have  been  employed  success- 
fully. Measures  of  these  opposite  types  are  both  credited  with 
cures,  and  in  a  larger  number  of  cases  at  least  afford  much  tem- 
porary relief.  Heat  is  the  better,  and  is  usually  sought  early 
in  the  treatment.  Hot  fomentations,  hot  wet  packs,  warm  and 
hot  fuU  baths  are  the  measures  most  easily  employed.  The 
partial  vapor  bath  may  be  used,  allowing  the  patient  to  sit  so  that 
the  heat  reaches  only  to  the  waist.  In  this  manner  a  greater 
degree  of  heat  may  be  applied  to  the  limbs  while  the  body  is  not 
so  much  affected.  This  avoids  any  sense  of  exhaustion.  Tem- 
peratures of  110°  to  120°  F.  (43.3°-48.9°  C.)  or  even  higher 
are  thus  permissible  for  a  period  of  fifteen  minutes.  The  patient 
may  then  be  placed  in  a  bath  of  9-5°  to  98°  F.  (35°-36.7°  C.) 
for  eight  minutes.  Toward  the  end  of  this  time  the  tem])era- 
ture  may  be  raised  to  110°  F.  (43.3°  C).  This  process  should 
be  repeated  daily  for  several  weeks. 


SCIATICA  185 

The  use  of  the  jet  douche  is  valuable.  The  patient  should 
have  the  preliminary  hot-air  bath  at  170°  F.  (76.7°  C.)  for  about 
six  or  eight  minutes,  or  until  perspiration  is  established.  The 
jet  douche  is  applied  for  from  thirty  seconds  to  one  minute  at  a 
temperature  of  90°  F.  (32.2°  C),  reduced  to  60°  F.  (15.6°  C), 
over  the  spine  and  to  the  seat  of  pain.  The  Scotch  douche  at 
105°  and  60°  F.  (40.6°  and  15.6°  C.)  is  then  applied  to  the  spine. 
The  pressure  should  be  from  15  to  20  pounds.  This  produces 
great  hyperemia  of  the  skin. 

It  is  said  that  in  Berlin  during  a  space  of  less  than  three 
years  over  500  cases  of  sciatica  were  treated  by  Brieger  in  the 
hydrotherapeutic  institution  of  the  university.  The  Scotch 
douche  is  the  measure  usually  employed. 

Pospischil  recommends  an  ice-water  coil  to  the  lumbar 
vertebrae,  so  as  to  produce  a  reflex  dilatation  of  the  blood-vessels 
of  the  lower  extremities;  combined  with  this  enveloping  the 
painful  limbs  in  bandages  (Longettenverbanden)  renewed 
several  times  a  day.  An  ice-bag  is  applied  over  the  heart,  and, 
finally,  soft  coverings  underneath  and  above  the  body.  The 
pack  is  left  in  place  for  from  six  to  eight  hours,  until  sweating 
has  ceased. 

The  Scotch  douche  is  very  commonly  used  in  the  German 
and  Austrian  cHnics.  Winternitz  has  been  using  this  method 
about  sixteen  years.  It  is  most  successful  in  recent  cases.  The 
contrast  douche  may  be  given  by  means  of  a  hot  steaming  fol- 
lowed by  a  cold  fan  douche.  The  trunk  is  then  covered  with 
a  well-wrung-out  moist  bandage,  over  which  a  dry  binder  is 
applied,  and  the  patient  is  allowed  to  take  active  exercise. 
Winternitz  uses  this  plan  in  sciatica  and  in  intercostal,  lumbar, 
and  brachial  neuralgia  with  success.^ 

Nearly  fifty  years  ago,  while  acting  as  surgeon  in  the  Civil 
War  in  the  United  States,  Dr.  Weir  Mitchell  treated  a  great 
many  cases  of  injuries  of  the  nerves  from  gunshot  and  other 
wounds.  These  injuries  were  followed  by  neuralgias,  neuritis, 
and  the  peculiar  burning  pain  termed  by  Dr.  Mitchell  caus- 
1  See  Ludwig  Schweinburg,  Handbuoh  der  Hydrotherapie,  p.  156. 


18G  HYDROTHERAPY 

algia.  Cases  of  sciatica  were  common.  It  was  found  that  dry 
cold  by  means  of  ice-bags,  if  employed  for  a  week  or  two, 
was  sure  to  be  of  service,  especially  when  there  was  local 
tenderness  of  the  nerve.  Under  its  use  the  nerves  lost  their 
irritability  and  shrunk  in  size;  the  treatment  was  kept  up  night 
and  day.  Dr.  Mitchell  says  that  when  cold  cannot  be  applied 
he  has  found  moist  heat  applied  to  the  whole  limb,  with  rest, 
sufficient. 

Ocean  baths  are  usually  inadvisable  for  persons  who  are  liable 
to  sciatica,  but  swimming  in  warm  j^ools  where  the  air  is  warm  or 
artificially  heated  is  often  beneficial. 

NEURITIS 

In  cases  of  traumatic  neuritis  a  cold  compress  or  an  ice- 
poultice  may  be  placed  over  the  nerve  at  the  seat  of  injury,  while 
the  distal  portion  of  the  limb  is  wrapped  in  moist  warm  flannels. 
Recently,  the  use  of  a  saturated  solution  of  magnesium  sulphate 
for  the  compress,  applied  at  a  temperature  of  50°  to  G0°  F, 
(10°-15.6°C.),  has  been  advocated  for  traumatic  and  alcoholic 
neuritis  (see  pj).  220  and  346). 

In  multiple  neuritis  and  non-traumatic  inflammation  of 
individual  nerves,  w^arm  and  hot  api)lications  or  warm  baths 
usually  give  relief.  If  the  disease  be  far  advanced,  hot  fomenta- 
tions are  useful. 

The  filiform  douche  and  steam  douche  (dampfdouche  ap- 
parat)  may  be  used  in  cases  where  counterirritation  is  desired. 
The  duration  of  all  douches  in  neuralgia  and  neuritis  shoulrl  be 
shorter  the  higher  the  pressure. 

Much  benefit  may  be  derived  from  the  warm  douche  or 
"spout "  of  water,  as  given  at  Virginia  Hot  Springs.  This  douche 
has  a  fixed  temperature  of  104°  F.  (40°  C.)  and  a  pressure  of 
from  14  to  16  pounds  to  the  square  inch.  It  is  followed  by  a 
bath  in  water  of  the  same  temperature,  lasting  from  five  to  ten 
minutes.  After  this  a  hot  dry  blanket  pack  for  ten  to  fifteen 
minutes  is  given,  followed  by  a  cool  shower  and  an  alcoholic 
rub,  avoiding  pressure  on  sensitive  parts. 


PARALYSIS    OF   ADULTS  187 

Peripheral  Neuritis. — The  measures  described  in  the  treat- 
ment of  sciatica  are  suitable  in  mam/  of  the  cases.  Hot  fomen- 
tations will  relieve  pain.  After  the  acute  stage  has  passed  the 
Scotch  douche  and  fan  douche  should  be  used  to  improve  the 
circulation  and  the  tone  of  the  muscles. 

PARALYSIS 

LOCAL  PALSIES 

In  local  palsies  from  any  toxic  agent,  such  as  lead,  arsenic, 
mercury,  or  in  those  peripheral  paralyses  due  to  pressure  or  other 
local  disturbance,  the  various  forms  of  hydrotherapy  are  always 
of  benefit  when  properly  applied.  Miners  for  gold,  silver,  quick- 
silver, lead,  and  arsenic  are  commonly  poisoned.  At  the  mines  or 
at  the  smelting  and  refining  works,  especially  where  the  processes 
includes  the  use  of  mercury  amalgam,  and  where  noxious  vapors 
are  given  off,  the  emploj^ees  are  liable  to  a  cachexia  which  de- 
mands careful  eliminant  treatment  and  tonic  measures.  In  this 
class,  also,  may  be  included  alcoholic  paralysis. 

The  wet  pack,  with  water  at  65°  F.  (18.3°  C.)  for  two  hours, 
may  be  used. 

Hot  baths,  followed  by  packs  and  massage,  are  beneficial. 
Later,  the  tonic  system  of  bathing,  involving  the  use  of  the  hot- 
air  or  electric  cabinet  and  needle,  jet,  Scotch,  and  fan  douches, 
are  indicated. 

In  paralysis  from  pressure  or  other  peripheral  cause,  similar 
measures  are  indicated,  and  in  these  cases,  as  in  toxic  paralysis, 
the  earlier  hydrotherapy  is  instituted  the  better. 

PARALYSIS  OF  ADULTS 
In  the  paralysis  of  adults,  such  as  posterior  and  lateral  spinal 
sclerosis,  spastic  paralysis,  and  paraplegia,  bathing  is  usually 
indicated;  but  in  these  cases  prolonged  heating  processes,  either 
in  the  cabinet  or  in  the  tub,  should  be  generally  avoided.  Pre- 
liminary heating  processes  of  short  duration  are  necessary,  as  a 
rule,  before  the  use  of  douches, 'but  these  need  not  be  in  the  least 
debilitating. 


188  HYDROTHERAPY 

LOCOMOTOR   ATAXIA 

Prolonged  warm  baths  at  95°  to  98°  F.  (29.4°-3().7°C.)  may 
bo  used  in  cases  of  locomotor  ataxia  and  paraplegia.  Tabetic 
patients  need  a  good  deal  of  care  and  assistance  in  carrying  out 
these  measures.  Their  station  is  often  bad,  and  in  their  naked, 
unsupported  feet  they  are  liable  to  totter  and  fall  if  douches  of 
any  force  are  applied.  There  should  be  provision  for  support 
for  the  arms,  so  as  to  prevent  accidents.  All  hot  pipes,  incan- 
descent lamps,  coils,  etc.,  should  be  carefully  protected  with 
screens  or  wire  netting. 

A  good  prescription  for  a  case  of  locomotor  ataxia  in  an  early 
.stage  is  as  follows: 

Hot-air  or  electric  cabinet  bath,  eight  to  ten  minutes. 
Circular  douche,  two  minutes,  105°  to  90°  F.  (40.G°-32.2°  C),  20  pounds. 
Jet  douche,  one  minute,  100°  to  85°  F.  (37.8°-29.4°  C),  15  pounds. 
Scotch  douche,  one-half  minute,   105°  and  85°  F.  (40.6°  and  29.4°  C), 

15  pounds. 
Fan  douche,  twenty  seconds,  85°  to  80°  F.  (29.4°-26.7°  C),  15  to  20  pounds. 
Alcohol  rub.     Reduce  minima  1  degree  daily  until  fan  douche  reaches 

70°  F.  {2I.1°C.).     Increase  pressure  of  jet  douche  and  Scotch  douche 

1  pound  daily  until  20  pounds  are  used,  provided  the  patient  bears  it 

well. 

In  the  more  advanced  stage  cold  water  is  not  so  well  borne. 
At  the  Montefiore  Hospital,  New  York,  in  Dr.  Baruch's  service, 
the  following  prescription  is  frequently  used : 

Hot-air  bath,  eight  to  ten  minutes,  short  of  perspiration. 
Circular  douche,  100°  to  105°  F.  (37.7°-40.5°  C.),  one  minute,  20  pounds. 
Fan  douche,   105°  to  120°  F.  (40.5°-48.8°  C),  gradually  and  rapidly 
moved. 

Baths  of  this  type  improve  the  circulation  and  are  a  valuable 
tonic  measure  for  all  debilitated  states  in  connection  with  local 
palsies  and  ])aral3^sis  of  adults,  provided  the  patient  can  walk 
and  stand  reasonably  well. 

In  presci'ibing  full  baths  it  is  not  necessary  that  they  contain 
much  gas  or  mineral  ingredients.  Hence,  long  journe3^s  to  for- 
eign watering-places   are  not  desirable;  neither  is  it  desirable 


PARALYSIS    OF    CENTRAL    ORIGIN  189 

that  tabetics  should  take  much  exercise  before  or  after  the  bath. 
In  general,  muscular  fatigue  should  be  avoided. 

Surf-bathing  is  not  wholly  counterindicated  in  tabes. 
The  author  has  noted  good  results  in  maintaining  the  general 
health  in  such  patients,  but  as  the  station  is  usually  poor,  there 
must  be  a  very  moderate  surf,  a  smooth,  hard  beach  of  gradual 
declivity,  and  considerable  physical  strength  to  make  sea-bathing 
permissible.  Excepting  in  favored  localities  the  water  is  too 
cold  and  the  risk  of  accidents  too  great  to  permit  of  bathing  in  the 
open  air.  The  decision  must  rest  with  the  capabihties  of  the 
individual.  It  has  been  remarked  that  the  Anglo-Saxon  race 
can  enjoy  and  profit  by  baths  at  lower  temperatures  than  other 
races.  There  is  probably  some  truth  in  this,  and  allowances  may 
be  made  accordingly. 

PARALYSIS  OF  CENTRAL  ORIGIN 

Hemiplegia,  glossolabiopharyngeal  paralysis,  acute  ascending 
paralysis,  Brown-S^quard  paralysis,  and  syphilitic  paralysis  are 
rarely  suitable  for  hydrotherapy  unless  of  the  mildest  type. 
Certainl}^  in  any  acute  stage  measures  of  this  kind  are  counter- 
indicated.  In  the  prodromal  stage  the  circulatory  disturbances 
attending  heat-producing  baths  might  hasten  an  apoplexy,  and 
hence  arterial  degeneration  with  high  blood-pressure  should  be 
met  with  only  the  mildest  hydrotherapeutic  measures.  They 
may  be  of  the  type  of  neutral  baths,  half-baths,  or  drip  sheets, 
and  their  effects  thould  be  watched  by  the  attending  physician. 
None  of  these  procedures  should  be  undertaken  without  first 
testing  the  blood-pressure  and  observing  the  effect  of  tentative 
measures. 

In  all  cases  where  hypertension  exists  any  extreme  of  tem- 
perature should  be  avoided.  A  warm  bath  should  be  given  daily 
and  at  its  close  a  cold  affusion  to  the  spine,  or  an  alternate  appli- 
cation of  hot  and  cold  water  to  the  spine,  followed  by  rubbing. 

The  only  forms  of  douche  advisable  are  the  fan  and  circular 
douches;  other  douches,  because  of  their  greater  volume,  may  be 
too  strenuous. 


190  HYDROTHERAPY 


OBESITY 


AMicn  the  increase  of  fat  disturbs  the  proper  function  of  any 
organ  or,  independently  of  that,  becomes  a  burden,  it  may  be 
considered  a  disease. 

Hydrotherapy,  in  connection  with  systematic  exercise  in 
dieting,  is  used  for  the  reduction  of  excessive  weight  with  more 
or  less  success.  There  is  a  type  of  the  overfat,  alcoholic,  high- 
living  man,  who  has  eaten  anil  drank  without  very  serious  effects, 
and  who  periodically  takes  some  form  of  reduction  cure  in  order 
to  keep  his  weight  down  and,  incidentally,  enjoy  life  once  more 
in  his  accustomed  way.  Patients  of  this  type  are  likely  to  have 
dilated  stomachs  and  sluggish  livers.  They  probably  have 
learned  to  use  laxative  mineral  waters  or  salts,  and  in  that  way 
obviate  any  serious  illness.  Besides  a  dilated  stomach,  careful 
examination  will  often  reveal  a  dilated  or  fatty  heart,  a  little 
tendency  to  a  dusk}^  look  about  the  face,  a  slightly  yellow  con- 
junctiva, a  quick  pulse,  and  a  tendency  to  dyspnea.  Hydro- 
therapeutic  measures  should,  therefore,  be  carefully  instituted, 
and,  if  possible,  the  patient  should  be  seen  by  the  physician 
during  and  shortlj'-  after  his  first  two  or  three  baths. 

Men  hear  a  great  deal  about  the  "boiling-out"  process  in 
use  at  certain  springs.  They  are  impressed  with  the  advantage 
of  extreme  measures,  and  are  usually  anxious  to  lose  a  great  deal 
of  flesh  in  a  minimum  of  time.  If  they  go  to  a  resort,  they  expect 
to  dispense,  more  or  less,  with  alcohol,  and  to  limit  their  dietary. 
It  is  remarkable  how  much  weight  is  lost  in  a  single  bath,  as 
shown  by  careful  weighing  before  and  afterward.  The  author 
has  known  a  patient  to  lose  5  pounds  in  a  single  bath  followed 
by  a  hot  pack.  A  patient  has  stated  that  he  lost  7  pounds  in  a 
single  bath  and  pack.  The  accompanying  charts  (Figs.  41-44) 
illustrate  the  loss  of  weight  in  men  while  bathing,  exercising, 
and  dieting.  The  weight  was  taken  without  clothing  before 
entering  the  bath,  and  on  being  dried  after  the  final  cold 
douche. 

The  regime  in  Case  1  provided  for  two  meals  a  day;  walking 


OBESITY  191 

seven  miles;  swimming  half  an  hour;  a  bath  consisting  of  a  warm 
douche  for  six  minutes  to  the  entire  body,  the  water  104°  F. 
(40°  C),  and  the  temperature  of  the  room  about  100°  F.  (37.8° 
C);  a  tub-bath  at  104°  F.  (40°  C.)  for  twenty  minutes,  followed 
by  a  hot  pack  with  eight  blankets  for  twenty-five  minutes. 
After  this,  the  patient  got  into  a  tubful  of  water  at  54°  to  60°  F. 
(12.2°-15.6°  C).  ^'N'hen  he  came  out  he  was  dried  and  was 
ready  to  rest  for  an  hour.  This  rather  strenuous  regime  is  suit- 
able only  for  a  man  in  perfect  health  and  of  perfect  habits,  to 
whom  the  term  ''patient"  seems  wholly  inappropriate.  The 
chart  shows  that  in  Case  1  as  much  as  4  pounds  were  lost  in 
a  single  bath,  and  as  much  as  5^  pounds  were  gained  in  twenty- 
four  hours  as  the  result  of  breaking  the  dietary  regime.^ 

In  Case  2-  the  conditions  were  somewhat  different.  While 
accustomed  to  take  a  good  deal  of  exercise,  there  was  a  decided 
alcohol  habit,  greater  indulgence  at  the  table,  a  very  slight  al- 
buminuria, and  a  sluggish  and  overloaded  liver.  The  patient 
was  inclined  to  break  through  the  regime,  but,  nevertheless, 
lost  10  pounds  in  a  month.  The  bath  adopted  by  patient  No.  2 
consisted  of: 

Hot  douche,  104°  F.  (40°  C),  ten  minutes. 
Full  bath,  104°  F.  (40°  C),  ten  minutes. 
Hot  blanket  pack,  twenty  minutes. 
Cold  douche,  50°  F.  (10°  C.)- 
Alcohol  rub. 

In  the  case  of  a  third  patient,  and  decidedly  alcoholic,  weigh- 
ing 261  pounds,  20  pounds  were  lost  in  twenty-two  days.  The 
bath  consisted  of  a  warm  douche  for  ten  minutes,  tub  for  fifteen 
minutes  at  104°  F.  (40°  C),  and  a  hot  blanket  pack,  using  six 
blankets.  The  author  has  not  found  the  hot-air  cabinet  followed 
by  circular  jet,  Scotch,  and  fan  douches,  so  effective  as  full  baths 
and  packs.  Even  when  the  cabinet  is  used  for  fifteen  or  twenty 
minutes  at  a  temperature  above  170°  F.  (76.7°  C),  there  is  not 
the  same  tendency  toward  the  loss  of  flesh.  The  following 
formula  is  sometimes  used  in  this  plan  of  treatment : 

1  See  Figs.  41  and  43.  2  gee  Fig.  44. 


192  HYDROTHERAPY 

Hot-air  batii  or  elect ric-ligl it  caliinet,  up  to  twenty  minutes. 

Circular  douche,  105°  down  to  70°  F.  (40.6-21.1°  C),  two  minutes,  20  to 

30  pounds. 
Jet  douche,  100°  down  to  70°  F.  (37.8°-21.1°  C),  one  minute,  20  to  30 

pounds. 
Scotch  douche,  105°  and  70°  F.  (40.6°  and  21.1°  ('.),  20  seconds,  20  to  30 

pounds. 
Fan  douche,  65°  F.  (18.3°  C),  ten  seconds,  20  to  30  pounds. 
Alcohol  rub.     Reduce  minima  1  degree  daily  to  60°  F.  (15.6°  C), 

Another  prescription  is: 

Hot-air  bath,  forty  to  sixty  minutes;  soap  shampoo. 
Half-bath,  temperature  of  70°  F.  (21.1  C),  three  to  five  minutes. 
Jet  douche  at  70°  F.  (21.1°  C),  twenty  seconds;  25  pounds. 
Dress  quickly  and  walk  until  fatigued. 

Repeat  daily  and  increase  duration  of  hot-air  bath,  and  lower  temper- 
ature of  douche  as  may  be  indicated. 

Unless  the  bath  given  can  be  shown  to  liavc  a  decided  in- 
fluence on  the  metabolism,  we  cannot  justly  attril)ute  loss  of 
weight  to  the  bathing  when  used  in  connection  with  dieting  and 
exercise.  The  author  believes,  as  he  has  already  stated,  that  the 
hot-air  or  electric-light  cabinet,  followed  by  the  various  douches 
in  succession,  constitutes  a  method  inferior  to  the  full  hot  bath 
with  subsequent  pad;.  The  exjieriments  of  Dr.  Otto  Folin  at 
the  McLean  Hospital  tend  to  confirm  this.  Nine  persons  were 
given  a  uniform  diet  adapted  to  the  capacity  of  the  individual, 
and  containing  a  known  amount  of  nitrogen.  After  this  diet 
had  been  continued  for  two  days,  the  urine  was  collected  for  each 
twenty-four  hours,  analyzed,  and  the  result  noted.  After  three 
or  four  days,  baths  were  given  for  about  the  same  period  of  time, 
but  no  particular  change  was  noted :  * 


Urine  in  twenty- 
four  hours. 


Nitrogen  excretion. 

Grains.  Cc. 

f  61.8  4470 


n        1  a      •     u       65.1  5100 

Case  1  (typical)  j   ^^^  ^„^^ 

[  62.4  4115 

1  For  a  criticism  of  this  experiment  see  pp 


Gain  or  loss 

Average,  four 

in  weight. 

days. 

Grams. 

+  220 

No  bath. 

—220 

Baths. 

+  150 

No  bath. 

+  150 

Baths. 

pp.  36  and  37. 

OBESITY 


193 


The  bathing  was  about  as  follows,  varying  somewhat  in 
special  cases : 

Hot-air  bath,  190°  F.  (87.8°  C),  to  perspiration  or  for  five  minutes. 
Circular  douche,  98°  to  90°  F.  (37.6°-32.2°  C),  one  minute;  30  pounds. 
Jet  douche,  70°  F.  (21.2°  C),  twenty  seconds;  30  pounds. 
Scotch  douche,   105°  F.  (40.6°  C),   alternating  with  70°  F.  (21.1°  C), 

one  minute;  30  pounds. 
Fan  douche,  60°  F.  (15.6°  C),  fifteen  to  twenty-five  seconds;  30  pounds. 

The  records  of  216  cases  in  which  similar  baths  were  given 
show  that  168  gained  weight  and  48  lost.  The  gain  was  from 
f  to  33|  pounds;  the  loss  was  from  h  to  22 J  pounds.     It  was 


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Fig.  41. — The  upper  line  shows  the  weight  each  day  on   entering  the  bath.     The 
lower  line  shows  the  weight  each  day  on  leaving  the  bath.      Case  1. 


noticed  that  the  gain  was  usually  preceded  by  an  initial  loss  of  a 
pound  or  two  during  the  first  week  of  the  baths.^ 

The  plan  of  treatment  depends  naturally  on  the  causes  of 
the  obesity,  and  these  are  usually  of  a  complex  character;  hence, 
there  is  no  single  remedy  for  obesity.  We  naturally  use  every 
measure    available.     Diet,    active    and    passive    exercise,    and 

^  George  T.  Tuttle,  American  Journal  of  Insanity,  October,  1904;  see  also 
p.  36. 

13 


194 


HYDROTHERAPY 


hydrotherapy  should  be  combined.  The  object  of  hydro- 
therapy should  be  to  provide  more  oxygen,  increase  the  excre- 
tion of  carbon  dioxid,  generate  heat,  and  promote  elimination. 
We  have  the  skin,  the  bowels,  kidneys,  and  the  lungs  upon  which 
to  work.  It  is  obvious  that  all  measures  that  stimulate  the 
appetite,  invite  sleep,  and  promote  constructive  metabolism 
would  defeat  our  ends.  The  plan  which  the  author  usually 
adopts  is,  for  the  first  three  days,  a  full  bath  at  104°  F.  (40°  C), 
for  twelve,  fifteen,  or  eighteen  minutes,  according  to  the  strength 
of  the  patient.     This  is  followed  by  a  hot  dry  pack  for  similar 


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Fig.  42. — On  November  1  and  8  bath  was  omitted,  being  Sunday,  and  patient  went 
to  luncheon  at  F.  Farm. 

periods,  a  cool  spray,  and  an  alcohol  rub.  The  patient  is  then 
partly  dressed  and  allowed  to  rest  for  twenty  minutes.  If  this 
treatment  be  in  the  morning,  he  devotes  the  afternoon  to  walk- 
ing, golf,  or  mountain  climbing,  as  the  ph3'Sical  condition  of  the 
patient  warrants.  In  the  evening  he  has  massage  for  an  hour, 
or  massage  may  be  given  before  rising.  Walks  of  a  5  and  10 
per  cent,  grade  are  provided,  so  that  systematic  exercise  may  be 
prescribed,  and  it  is  remarkable  what  may  be  done  by  men  and 
women  who  are  gradually  led  to  take  up  this  form  of  physical 
training.     The  accompanying  charts  illustrate  results  obtained 


OBESITY 


195 


by  the  author  in  cases  under  the  combined  treatment..    (See 
Figs.  41-44.) 

A  vigorous  and  at  the  same  time  a  rational  treatment  of 
obesity  in  patients  presenting  no  comphcation  of  the  kidney, 
stomach,  or  hver  is  that  employed  by  Dr.  William  S.  Sadler,  of 
Chicago,  and  is  described  in  a  personal  communication  to  the 
author : 


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Fig.  43. — The  descending  line  shows  the  loss  of  weight  during  the  bath.     Case  1. 


1,  Begin  the  procedure  by  short  electric-light  bath  or  some 
other  form  of  sweating.  Carry  it  to  just  the  point  of  free  per- 
spiration. 

2.  The  patient  is  immediately  placed  under  the  cold  shower 
and  needle  douche.  Water  is  given  at  the  lowest  possible  tem- 
perature and  at  a  maximum  pressure  (35  to  50  pounds).  This 
treatment  is  kept  up  until  the  patient  is  thoroughly  cold.  On 
coming  from  this  the  patient  is  immediately  dried  with  a  sheet 
and  then  the  next  step  in  the  regime  begins. 


196 


HYDROTHERAPY 


3.  Active  physical  exercise,  such  as  walking  up  and  down  in 
the  treatment  room,  swinging  of  the  arms,  taking  breathing 
exercises,  bending,  etc.  A  good  temperature  to  have  the  room 
in  which  the  obese  are  to  work  is  from  70°  to  75°  F.  (21.1°- 
23.9°  C).  This  exercise  is  continued  until  there  is  a  thorough- 
going reaction  and  the  point  of  perspiration  is  again  reached, 
whereupon  the  patient  is  again  placed  under  the  cold  shower-bath 
and  the  same  performance  rejx'atcnl.     This  regime  is  repeatedly 


Fig.  44. — The  descending  line  shows  the  loss  of  weight  during  the  bath.     Case  2. 

administered  as  long  as  the  patient  can  stand  it  without  any 
sensations  of  fatigue  or  nervous  weakness.  It  is,  therefore, 
best  to  inaugurate  this  regime  by  th(>  graded  method  until  the 
patient  can  endure  it,  but  after  the  first  few  days  the  powers  of 
endurance  are  strengthened  and  repetitions  of  the  above  proc- 
esses are  quite  possible. 

In  robust  cases,  not  in  any  way  debilitated.  Dr.  Sadler 
carries  out  these  measures  at  10  o'clock  in  the  morning  and 
again  at  4  in  the  afternoon.      In  his  experience  it  acts  much 


SYPHILIS  197 

better  than  the  sweating  process,  which  he  thinks  weakening. 
Patients  will  follow  the  regime  when  properly  administered 
and  carefully  observed,  losing  in  flesh  each  day,  but  gaining  in 
muscular  strength.  It  gives  the  maximum  carbohydrate  oxy- 
dation  with  minimum  proteid  metabolism.  When  fatty  degen- 
eration of  the  heart  is  present,  emphysema,  or  other  compli- 
cations, modifications  of  the  regime  will  suggest  themselves. 

Some  cases  of  obesity,  where  there  is  no  heart  lesion,  but 
where  there  is  a  tendency  to  palpitation  on  much  exertion,  are 
greatly  relieved  by  the  application  of  an  ice-bag  to  the  heart  at 
the  time  the  initial  heating  procedure  is  taken. 

It  has  been  estimated  that  in  a  regime  such  as  outlined  about 
a  fifth  of  the  units  of  energy  would  be  represented  in  work  and 
about  four-fifths  in  heat  production,  so  that  any  plan  combining 
increased  muscular  exercise  as  well  as  the  development  of  excess- 
ive heat  production  will  be  followed  by  a  reduction  of  weight. 

Water  drinking  should  be  restricted  between  meals  and  at 
night,  but  may  be  allowed  at  the  table.^ 

EXOPHTHALMIC  GOITER 

Not  a  great  deal  may  be  expected  from  hydrotherapy,  ex- 
cepting in  the  form  of  local  applications.  These  include  cold  ap- 
plications to  the  thyroid  gland  by  means  of  ice-bags  or  the  Leiter 
coil;  and  ice-bags  to  the  heart  or  nape  of  the  neck  for  tachy- 
cardia. For  the  nervousness,  warm  baths  in  either  fresh  or  salt 
water,  half-baths,  and  douches  to  the  spine  are  advised.  Turk- 
ish baths,  Nauheim  baths,  and  sea-baths  are  counterindicated. 

SYPHILIS 

Owing  to  the  success  attending  the  treatment  of  syphilis 
at  sulphur  spas,  of  which  Aix-la-Chapelle  is  a  type,  much  stress 
has  been  laid  on  the  action  of  the  sulphur  water  externally; 
but  at  all  spas  the  waters  are  used  internally  as  well,  and,  what  is 

^  For.  a  discussion  of  this  subject  see  Obesity,  Carl  von  Noorden;  see 
also  p.  400. 


198  HYDROTHERAPY 

more  important,  tlic  patients  are  almost  invariably  treated 
energetically  with  mercurials  internally  or  by  inunction  or  by 
large  doses  of  iodids.  In  connection  with  systematic  bathing 
and  massage  the  medicinal  treatment  is  greatly  increased  in 
efficacy. 

Undoubtedly,  at  the  spas  which  have  been  mentioned  the 
experience  of  the  physicians  under  whose  direction  baths  are 
given  leads  them  to  judge  with  unusual  certainty  of  the  ap- 
propriate amounts  of  medicines  in  particular  cases.  They 
are  enabled  to  push  these  to  the  maximum  of  tolerance,  and  in 
this  lies  their  success.  This  is  recognized  by  practitioners 
at  Hot  Springs,  Arkansas,  Mount  Clemens,  and  Aix-la-ChapcUe, 
who  acknowledge  that  their  results  are  due  to  the  physical 
qualities  of  the  baths  and  not  to  the  chemical  ingredients  of 
the  water. 

W.  R.  Huggard  *  says :  "Formerly  sulphur  waters  were  sup- 
posed to  render  mercurial  treatment  more  efficacious  or  more 
easily  borne — a  claim  that  cannot  be  substantiated  and  is  now 
rarely  heard."  Dr.  L.  Duncan  Bulkley^  states  that  much  harm 
often  results  from  the  false  security  which  patients  have  who  have 
undergone  what  is  called  a  "cure"  at  one  of  these  resorts. 
It  has  been  clearly  demonstrated  that  syphilis  cannot  be  cured 
by  any  brief  course  of  treatment,  however  severe.  It  is  true 
that  the  "cures"  are  distinctly  beneficial.  This  is  almost  un- 
questionably due  to  the  active  and  heroic  mercuric  treatment  to 
which  patients  have  been  subjected,  combined  with  change  of 
air  and  scene,  together  with  the  natural  hope  and  expectation 
of  benefit.  Dr.  Bulkley  does  not  recall  a  single  instance  in  which 
he  has  regarded  it  as  either  beneficial  or  wise  for  the  patient  to 
undertake  this  cure  (by  mineral  baths)  at  any  great  personal 
sacrifice.  His  conclusions  are  drawn  from  20,000  personal 
dermatologic  cases  in  public  and  private  practice,  of  which  12 
per  cent,  were  syphilis. 

^  Handbook  of  Climatic  Treatment,  Including  Balneology,  London, 
1906. 

*  Medical  Record,  New  York,  vol.  Lxxii,  No.  6,  1907. 


SYPHILIS  199 

Regime  at  Aix-la-Chapelle. — It  may  not  be  out  of  place 
to  refer  to  the  regime  which  patients  follow  at  Aix-la-Chapelle  and 
Hot  Springs,  Arkansas,  from  which  it  will  be  seen  that  the  med- 
ical treatment  is  accorded  its  proper  place,  the  physicians  recog- 
nizing that  the  thermal  springs  are  no  more  able  than  any  other 
medicinal  waters  to  cure  syphilis.  Their  value  depends  on  the 
fact  that  they  facilitate  the  use  of  mercury — the  only  real  specific 
competent  to  eradicate  the  virus  and  to  exercise  a  favorable  in- 
fluence at  all  stages  of  the  disease.  It  is  particularly  desirable 
to  concentrate  as  much  treatment  as  possible  into  the  first  few 
years,  or  even  months,  for  only  in  this  way  can  the  development 
of  the  tertiary  stage  be  avoided. 

Mercurial  inunction  is  to  be  preferred  to  administration  per  os 
as  producing  a  more  energetic  result  and  being  free  from  the 
risk  of  intestinal  complications.  It  is  this  method  which  is 
almost  exclusively  employed  at  Aix,  and  it  is  claimed  to  have 
more  permanent  effects  than  those  obtained  through  other  chan- 
nels of  administration.  To  secure  a  satisfactory  absorption  of 
the  remedy  it  is  necessary  that  the  skin  be  properly  prepared. 
This  is  accomplished  by  means  of  the  thermal  baths,  which 
soften  the  epidermis  and  dilate  the  orifices  of  the  glands.  The 
inunction  is  performed  by  a  certificated  ''frotteur,"  who  mas- 
sages the  prescribed  quantity  of  the  ointment  into  the  skin. 
It  is  believed  that  the  mercury  is  distributed  through  the 
body  as  an  albuminate.  As  douche-massages,  thermal,  vapor, 
and  electric  baths  increase  the  amount  excreted  in  the  urine, 
these  are  employed  with  a  view  to  quicken  the  metabolic 
processes,  in  which,  of  course,  mercury  plays  its  appropriate 
part. 

To  avoid  any  risk  of  stomatitis,  disinfection  of  the  mouth 
with  dentifrices  and  mouth-washes  is  practised.  Every  morning 
the  patient  drinks  two  or  three  glasses  of  spring  water,  to  which, 
if  there  is  sluggishness  of  the  bowels,  a  teaspoonful  of  Aix- 
la-Chapelle  salts  is  added.  This  is  followed  by  a  thermal  bath. 
The  portion  of  the  surface  that  is  to  be  the  site  of  the  next 
rubbing  is  then  thoroughly   cleansed   with  soap   and   water, 


200  HYDROTHERAPY 

and  care  is  taken  to  avoid  tlic  use  of  soap  or  of  friction  by 
the  towel  over  parts  which  have  previoiit«ly  been  subjected 
to  inunction.  Occasionally  a  vapor  l)ath  or  douche-massage 
precedes  the  ordinary  thermal  bath.  Next,  the  patient  is  in- 
structed to  rest  in  bed,  and  about  an  hour  after  breakfast 
the  inunction  is  performed.  The  ointment  used  is  a  33  per 
cent.  ung.  hydrarg.  It  is  applied  on  different  parts  according 
to  a  regular  daily  sequence — legs,  thighs,  back,  abdomen,  iliac 
regions,  and  arms.  Before  the  midday  meal  another  glass  of 
spring  water  is  taken  with  a  view  to  jjromote  appetite.  After 
every  meal  the  patient  uses  a  salol  and  chlorate  of  potassium 
tooth  paste,  and,  in  addition,  he  emplo3's  every  half-hour  a  solu- 
tion of  aluminium  acetico-tartaricum  as  a  mouth-wash. 

The  diet  during  the  whole  of  the  treatment  should  be  as  sup- 
porting as  possible.  Milk  should  be  taken  freely.  Red  wine 
with  seltzer- water  may  be  permitted  with  meals.  Smoking, 
especially  during  the  secondary  period,  is  apt  to  provoke  mu- 
cous plaques  in  the  mouth  and  throat. 

Frequent  observation  is  made  of  the  urine,  and  the  devel- 
opment of  albuminuria  demands  a  pause  in  the  treatment. 

The  above  are  the  details  of  an  ordinary  course  of  inunction. 
In  particular  circumstances  supplementary  measures  may 
be  necessary.  Thus,  any  signs  of  gvmmatoas  development 
call  for  potassium  iodid,  which  is  given  in  doses  of  75  to  100  gr., 
dissolved  in  milk  or  soda-w^ater.  ^^'hen  the  gumma  subsides, 
iodid  is  no  longer  necessary,  but,  to  be  on  the  safe  side,  injec- 
tions of  25  per  cent,  iodipin  (iodized  sesame  oil,  Merck)  may  be 
given.  This  insures  a  protracted  action,  as  it  is  found  that  even 
six  months  after  the  injection  of  200  gr.  of  iodipin  the  urine  still 
gives  a  definite  iodin  reaction.  Iodii)in  further  appears  to  in- 
crease the  tolerance  for  the  mercurial  inunction,  and  this  is  con- 
tinued simultaneously. 

Another  supplementar}^  remedy  is  sarsaparilla.  This  is 
indicated  where  former  excessive  mercurial  treatment  has  so 
influenced  the  tissues  that  a  prompt  response  to  the  inunction  is 
not  obtained. 


SYPHILIS  201 

Sulphur  Waters. — Iii  a  recent  paper  by  Dr.  Jean  Dardel/ 
of  Paris,  great  stress  is  laid  on  the  use  of  sulphur  waters  in 
S3'philis,  These  are  used  under  his  direction  at  Aix-les-Bains. 
The  sulphurous  calcic  waters,  having  a  temperature  of  113°  F. 
(45°  C),  are  used  externally  in  the  "Aix  douche"  (see  p.  263); 
in  the  form  of  vapor  baths ;  and  internally,  for  which  the  Marhoz 
water  is  specially  employed.  The  waters  of  MarUoz  are  brought 
from  a  neighboring  spring.  It  is  the  most  sulphurous  of  the 
three  springs  which  occur  in  that  locality,  and  has  a  tempera- 
ture of  57.2°  F.  (14°  C).  It  is  easily  borne  by  the  stomach 
and  is  considered  eminently  suitable  for  the  internal  sulphur  cure. 

It  is  claimed  that  used  internally  sulphur  waters  have  a 
general  tonic  and  exciting  action.  Dardel  states,  however,  that 
in  his  opinion  this  stimulant  action  depends  more  on  the  mode  of 
treatment  than  on  the  waters  themselves,  and  that  the  thermal 
fever  w^hich  has  been  described  by  certain  authors  is  due  to  a  too 
energetic  and  rapidly  applied  treatment.  The  cure  has  a  favor- 
able action  on  all  the  organs.  The  appetite  is  stimulated,  the 
red  corpuscles  are  increased  in  number,  the  urine  is  more  abun- 
dant, and  the  quantity  of  urea  eliminated  is  more  considerable. 
Nutrition  which  is  retarded  by  the  direct  action  of  syphilis  is 
stimulated  and  activated  by  the  use  of  sulphur  waters. 

Dardel  takes  a  very  sensible  view  of  the  matter  when  he  says 
that  the  treatment  of  syphilis  by  the  use  of  sulphur  does  not 
cure  alone,  but  forms  a  very  valuable  auxiliary  treatment,  which 
may  be  combined  with  a  course  of  mercurial  treatment ;  also  that 
the  water  will  help  greatly  in  the  absorption,  action,  and  ehm- 
ination  of  the  drug.  The  cure  is  indicated  at  any  period  of  the 
disease,  since  nutrition  suffers  at  all  stages. 

Counterindications  and  Indications. — Patients  suffering  from 
arteriosclerosis  or  liver  trouble,  and  those  who  are  highly  nervous, 
should  not  undergo  an  active  sulphur  cure.  It  is  especially 
indicated  in  those  who  take  mercury  badly,  or  who  can  tolerate 
but  a  small  dose  of  it,  and  in  those  in  whom  the  therapeutic 
action  of  mercury  is  not  easilj"  obtained.     It  is  also  indicated  in 

1  Medical  Record,  New  York,  July  20,  1907. 


202  HYDROTHERAPY 

cases  of  groat  destruction  of  tissue,  or  severe  infections  in  feeble 
or  worn-out  patients,  and  in  lesions  of  the  nervous  system, 
ulcerative  lesions  that  threaten  great  destruction  to  the  organs 
affected,  and  such  other  lesions  in  which  prompt  treatment  is 
demanded.  The  treatment  strengtliens  the  patient  and  increases 
his  tolerance  for  mercury.  The  sulphur  of  the  water  is  converted 
into  alkaline  sulphids,  some  of  which  are  oxidized  into  hypo- 
sulphites and  sulphites;  but  the  most  of  the  sulphur  forms  hydro- 
gen sulphid,  which  is  eliminated  by  the  lungs  and  skin.  The 
water  has  a  general  tonic  and  exciting  action,  and  liberates  mer- 
curial compounds  stored  up  in  the  system. 

The  Hot  Springs  of  Arkansas,  all  the  bathing  establish- 
ments of  which  arc  on  United  States  Government  property 
(see  p.  19),  are  largely  used  for  the  treatment  of  syphilitic 
affections. 

It  is  usual  at  first  to  order  a  Ijath  of  six  minutes'  duration  at 
a  temperature  of  93 °  to  95 °  P\  r33.9°-35°  C),  to  be  gradually 
increased  in  successive  baths  to  100°  F.  (37.8°  C),  for  ten 
minutes.  After  the  tub-bath,  ])acks  in  hot  blankets,  employing 
two,  three,  four,  or  five  blankets.  Alcohol  rubbing  is  not  used, 
as  it  is  believed  to  prevent  elimination  through  the  skin.  Cold 
douches  are  not  usually  given  either,  although  cold  cloths  may 
be  applied  to  the  head  if  there  be  a  tendency  to  headache. 

Vapor  baths  may  be  medicated  with  (>ither  calomel  or  sulphur. 
In  treating  early  syphilis,  especially  when  there  are  extensive 
eruptions,  15  to  30  gr.  of  calomel  may  be  volatilized  by  means 
of  special  apparatus,  with  just  sufficient  water  to  excite  the  skin 
to  moderate  action.  Preliminary  steaming  is  not  necessary, 
as  the  heat  required  to  volatilize  the  calomel  is  enough  to  excite 
sufficient  perspiration.  For  sulphur  vapor  baths,  1  or  2  ounces 
of  sublimed  sulphur  may  be  used.  Patients  with  syphilis,  rheu- 
matism, and  acne  may  be  benefited  by  such  treatment. 

In  iridocyclitis,  with  synechia^  and  vitreous  opacities  due 
to  syphilis,  hot  baths  and  sweating  processes,  such  as  hot  packs, 
should  be  used  in  connection  with  specific  and  local  treatment 
to  the  eyes. 


SKIN  DISEASES  203 

Cutaneous  Manifestations. — It  has  been  noted  that  baths 
are  liable  to  induce  cutaneous  manifestations  in  syphilis,  espe- 
cially when  given  before  the  secondary  stage.  They  some- 
times reveal  a  latent  syphilis  and  in  this  way  favor  a  positive 
diagnosis.  As  a  general  measure  a  weekly  Turkish  bath  is  com- 
monly advised  in  the  routine  treatment  of  syphilis.  The  author 
thinks  this  a  reprehensible  practice  unless  the  management  of  the 
public  Turkish  bath  establishment  be  informed  as  to  the  nature 
of  the  disease  and  suitable  provision  be  made  to  avoid  the  danger 
of  transmission  of  the  disease  to  attendants  and  the  patrons  of 
the  baths.  At  certain  resorts  which  cater  to  this  class  of  patients 
such  provision  is  made,  and  the  attendants  who  give  inunctions 
and  baths  for  syphilis  are  both  cautious  and  efficient,  and  hence 
carry  out  these  measures  far  better  than  these  when  left  to  the 
patient  himself. 

SKIN  DISEASES 

Mineral  waters  have  always  had  a  reputation  for  the  cure  of 
skin  diseases.  Few  advertisements  of  mineral  springs  fail  to 
mention  their  efficacy  in  such  cases.  There  must  be  some  foun- 
dation for  this  belief,  which  has  existed  from  time  immemorial. 
To  relieve  fecal  accumulation  is  the  first  step  in  the  treatment  of 
inflammatory  diseases  such  as  eczema  and  acne.  It  is  necessary 
in  many  cases,  therefore,  to  eliminate  the  true  causes  of  these 
affections  by  administering  the  purgative  waters  such  as  Sara- 
toga Congress  Water,  Crab  Orchard,  Abilena,  Hunjadi,  Fried- 
richshall,  Pullna,  or  Pluto 

Skin  diseases  may  reciuire  variously  modified  baths.  The 
following  may  be  used  in  30  gallons  of  water  at  a  temperature 
of  100°  to  104°  F.  (37.8°-40°  C.) : 

Emollient  Baths. — Bran,  2  to  6  pounds,  to  30  gallons  of 
water;  potato  starch,  1  pound;  gelatin,  1  to  3  pounds;  linseed,  1 
pound.  These  are  useful  in  erythematous,  itchy,  and  scaly  dis- 
eases, as  for  example,  psoriasis. 

Alkaline  Baths. — Bicarbonate  of  soda,  oij  to  x;  carbonate 
of  potash,  §ij  to  vj;  borax,  §iij.     The  bicarbonate  may  be  used 


204  HYDROTHERAPY 

with  bran  liquor,  made  by  infusing  a  gallon  of  bran.  Useful  in 
eczema,  psoriasis,  urticaria,  lichen,  and  prurigo,  where  there  is 
much  local  irritation. 

Potassium  sulphid,  oij  to  iv  to  each  bath.  Another  formula 
useful  in  itch,  chronic  eczema,  lichen,  and  psoriasis  is: 

Precipitated  sulphur,  5ij;  sodium  hypophosphite,  5J;  dilute 
sulphuric  acid,  oss,  mixed  in  a  pint  of  water  and  added  to  the 
30  gallons  of  the  bath. 

Ichthyol  baths,  in  the  strength  of  oviij  to  x  (250-300  gm.) 
to  40  gallons,  have  been  used  by  Dubois  in  cases  of  pruritus, 
pityriasis,  psoriasis,  eczema,  and  scabies. 

Simple  vapor  and  hot-air  Turkish  baths  are  not  specially 
valuable  in  skin  diseases.  They  are,  as  a  rule,  injurious  in 
eczema,  which  forms  the  largest  class  of  diseases  of  the  skin. 

Precautions. — Naturally,  in  treating  contagious  skin  dis- 
eases, precautions  must  be  taken  that  the  tubs  and  other  utensils 
used  in  the  bath,  as  well  as  the  hands  of  the  operator,  be  absolutely 
disinfected  afterward.  It  would  be  nothing  less  than  criminal 
to  neglect  these  precautions.  Patients  suffering  from  syphilis, 
leprosy,  scabies,  tinea,  and  the  less  communicable  skin  diseases 
should  never  be  bathed  in  tubs  to  be  used  by  others.  In  resorts 
like  Mount  Clemens,  Michigan,  and  Hot  Springs,  Arkansas, 
special  porcelain  tubs  are  assigned  to  sy[)hilitic  cases.  When 
cases  are  treated  in  hotels,  boarding-houses,  sanitaria,  and  hos- 
pitals the  physician  should  hold  himself  in  honor  bound  to  see 
that  no  contagion  can  possibly  be  left  when  it  becomes  necessary 
to  bathe  any  case  of  this  type. 

PSORIASIS 
Arsenical  Waters. — In  the  more  refractory  skin  diseases, 
such  as  psoriasis,  the  internal  use  of  arsenical  waters,  such  as  those 
of  Royat,  La  Bourboule,  Roncegno,  and  Lexdco,  are  useful. 
The  latter  is  the  strongest  arsenical  water  known,  containing 
about  yV  gr.  per  pint,  as  well  as  persulphate  of  iron.  Not  more 
than  a  tablespoonful  is  usually  prescribed,  or  about  3^  gr.  of 
arsenous  acid.     La  Bourboule  contains  about  2  gr.  of  sodium 


PSORIASIS  205 

arsenate  in  the  gallon  (0.028  to  1000  cc).  The  Royat  Spring 
is  richer  in  iron  than  La  Bourboule,  but  contains  only  one-sixth 
the  amount  of  sodium  arsenate,  or  about  +  gr.  per  gallon. 

Sulphur  waters  have  been  successfully  used  in  treating 
psoriasis.  They  are  usually  applied  externally.  Those  best 
adapted  for  this  purpose  in  America  are  Richfield  Springs, 
Sharon  Springs,  in  Nev/  York,  White  Sulphur  Springs,  in  West 
Virginia.  In  England  those  of  Harrogate  and  Strathpeffer, 
in  Great  Britain;  Aix-la-Chapelle,  Germany;  Schinzerach, 
Switzerland;  and  Bareges,  in  the  Pyrenees  in  France. 

Thermal  baths  in  weak  alkaline  water  are  also  used.  Those 
of  the  Warm,  Hot,  and  Healing  Springs  in  Virginia  and  of  Hot 
Springs  in  Arkansas  belong  to  this  class.  Corresponding  baths 
are  found  at  Bath  and  Buxton,  England;  at  Leuk,  Switzerland, 
altitude  4500  feet.  Canton  of  Valois;  at  Aix-les-Bains,  France. 
The  latter  springs  have  a  temperature  of  112°  to  116°  F.  (44.4°- 
46.7°  C).  The  waters  of  Plombieres,  in  the  Vosges  Mountains 
in  France,  are  used  in  cases  of  psoriasis  as  well  as  pemphigus. 
They  are  applied  in  a  continuous  bath,  the  natural  temperature 
of  117°  F.  (47.2°  C.)  being  moderated.  The  altitude  of  Plom- 
bieres is  1310  feet  and  the  climate  is  bracing.  At  Baden,  near 
Vienna,  and  at  the  Sulphur  Springs  of  Leuk,  Switzerland,  excel- 
lent results  are  obtained. 

The  wet  pack  is  useful  in  extensive  psoriasis  to  remove  scales 
and  diminish  hyperemia.  Notwithstanding  a  great  many 
testimonials  regarding  the  efficiency  of  mineral  springs  in  the 
treatment  of  psoriasis  and  a  rather  widespread  faith  among 
members  of  the  medical  profession  in  the  use  of  baths  in  this 
disease,  some  of  the  most  distinguished  dermatologists  are  not 
so  sanguine.  Dr.  L.  D.  Bulkley,^  of  New  York,  in  a  recent 
article  on  the  treatment  of  psoriasis,  does  not  mention  baths  at 
all,  and  does  not  believe  that  they  are  of  any  special  use  in  this 
affection.  This  was  somewhat  surprising  to  the  writer,  but 
correspondence  showed  that  this  position  was  the  result  of  large 
experience.  However,  the  author  would  suggest  that  while 
1  Journal  of  the  American  Medical  Association,  Nov.  17,  1906. 


206  HYDROTHERAPY 

cures  may  not  be  expected  from  hydrotherapy  or  mineral  baths 
at  resorts,  owing  to  the  chronic  nature  of  the  disease,  neverthe- 
less some  benefit  may  accrue,  just  as  in  cases  of  syphilis,  and  that 
subsequent  measures,  such  as  prolonged  and  rigid  vegetable 
diet  and  the  use  of  ointments,  may  accomplish  the  actual  cure. 

LEPROSY 

Fortunately,  this  disease  is  so  rare  in  America  and  in  Europe 
that  its  treatment  is  practically  unknown  except  in  the-  leper 
colonies.  The  discovery  of  a  case  in  the  United  States  throws 
the  community  into  a  panic,  and  the  health  authorities  are  more 
concerned  with  getting  rid  of  him  than  in  treating  him. 

The  author  has  had  no  personal  experience  with  this  disease, 
but  the  following  plan  of  treatment  has  been  found  to  relieve 
the  neuritic  ))ains  from  which  many  lepers  suffer: 

Medicated  Baths.* — Patients  suffering  from  ulcerated  tuber- 
cles or  thickened  skin  or  in  whom  there  is  neuritis  or  lymphade- 
nitis derive  benefit  from  these  baths.  The  medicated  baths 
used  are  the  alkaline,  sodium  bicarbonate  or  borax,  1  pound  to 
the  bath;  astringent,  alum,  \  pound  to  the  bath;  potassium 
sulphate,  J  pound  to  the  bath.  The  one  which  has  proved 
most  beneficial  is  a  warm  or  hot  medicated  bath,  made  by 
adding  to  the  water  (30  to  40  gallons)  an  infusion  of  eucalyptus 
leaves  (4  gallons). 

The  bath  should  be  given  twice  daily,  the  water  of  the 
morning  bath  being  at  a  temperatui'e  of  from  95°  to  104°  F. 
(35°-40°  C).  Enough  water  should  be  used  to  immerse  the  body 
(30  to  40  gallons).  The  patient  should  remain  in  the  bath  at 
least  fifteen  minutes,  and  during  the  immersion  active  friction 
should  be  kept  up  on  all  parts  of  the  body.  Immediately  after 
bathing  the  patient  should  be  thoroughly  rubbed  with  a  towel 
coarse  enough  to  cause  exercise  to  the  skin.  This  should  be 
followed  with  an  ointment  composed  of: 

^  Hollman,  Journal  American  Medical  Association,  1906,  p.  1815. 


LEPROSY  207 

Olei  eucalypti, 

Ung.  sulphuris aa  3iv  (15) 

Lanolini o  ij  (60) . — M. 

Ft.  ungt. 
This  ointment  should  be  thoroughly  rubbed  into  the  skin,  removing  all 

excess. 

The  evening  hath  should  be  at  a  temperature  of  105°  F. 
(40.6°  C),  and  should  be  gradually  raised  as  high  as  can  be  safely 
borne,  about  110°  F.  (43.3°  C).  After  tliis  hot  bath  the  patient 
should  be  wrapped  in  a  warm  blanket  and  allowed  to  remain 
thus  covered  for  ten  minutes.  This  causes  the  sweat  glands  to 
act  freely,  thus  removing  waste  material  from  an  already  dis- 
eased body.  The  rubbing  with  a  coarse  towel  and  the  use  of  the 
ointment  should  then  follow.  This  hot  eucalyptus  bath  assures 
the  patient  a  good  night's  sleep,  a  thing  most  highly  valued  by 
a  leper  suffering  from  neuritic  pains. 

Combination  Treatment. — Dr.  Matias  Duque,^  of  Havana, 
has  recently  reported  cures  in  leprosy  from  a  combination  of 
various  measures  in  which  baths  have  a  distinct  place.  In  the 
first  period  of  the  disease  cases  are  cured  in  eight,  ten,  or  twelve 
months;  in  the  second  period  60  per  cent,  of  the  patients  are 
cured  in  two  to  five  years.  But  in  the  third  period,  when  all 
the  organs  are  affected,  there  is  no  cure.  Internally  he  gives  an 
extract  of  the  red  mangrove  or  mangle.  The  bark  is  extracted 
with  alcohol  and  preserved  in  glycerin;  this  is  also  added  to  the 
baths. 

As  to  baths,  he  says:  "The  immersion  bath  should  cover  the 
entire  body,  and  should  be  taken  on  going  to  bed,  at  a  tempera- 
ture from  102.2°  to  104°  F.  (39°-40°  C),  or  as  the  patient 
may  be  able  to  endure  it.  The  duration  of  the  bath  should  be 
from  fifteen  to  twenty  minutes,  and  care  should  be  taken  that  the 
temperature  be  always  the  same,  that  the  body  be  immediately 
wiped  or  thoroughly  dried  without  rubbing  or  friction  whatso- 
ever, and  the  patient  be  at  once  put  to  bed  well  wrapped.  The 
bath  is  more  efficacious  if  a  decoction  of  the  mangle  (mangrove) 

^  American  Journal  of  Dermatology,  December,  1907. 


208  HYDROTHERAPY 

be  made  in  sufficient  quantity  to  redden  the  water  used  in  said 
bath." 

The  baths  undoubtedly  improve  the  circulation,  stimulate 
the  sweat  glands,  and  soften  the  skin. 

ECZEMA 
Continuous  Bath. — In  1877  Ferdinand  von  II('l)ra  intro- 
duced the  continuous  bath  as  a  cure  for  chronic  eczema  and  other 
chronic  squamous  diseases.  In  general  it  has  not  been  considered 
wise  to  apply  water  in  eczema,  but  when  the  affection  is  generally 
distributed  over  the  botly  and  of  a  chronic  type,  the  continuous 
bath  softens  the  skin,  hastens  desquamation,  and  moderates 
or  entirely  relieves  the  excessive  itching.  In  subacute  cases  a 
cool  bath  in  which  some  borax  or  sodium  bicarbonate  has  been 
dissolved  affords  comfort.  The  addition  of  flaxseed,  c<jrnmeal, 
or  bran  to  the  baths  softens  the  skin  and  prepares  it  for  ointments 
if  these  be  required. 

PARASITIC  SKIN  DISEASES 

In  parasitic  skin  diseases,  such  as  tinea  versicolor  or  dissemi- 
nated scabies,  baths  are  very  useful  in  improving  the  skin's 
tone.  Disseminated  itch  is  very  common  in  France  and  Austria, 
and  it  is  customary  at  the  large  clinics  to  order  a  full  hot  bath 
with  green  soap,  after  which  Wilkinson's  ointment  or  Hebra's 
modification  is  u.sed. 

At  University  College,  London,  they  use  sulj)hur  baths.  The 
patient  is  soaked  for  fifteen  minutes  in  a  solution  of  4  ounces  of 
sulphid  of  potassium  to  30  gallons  of  water,  and  is  then  scrubbed 
with  a  stiff  brush  and  again  placed  in  the  bath  for  fifteen  minutes, 
after  which  he  is  allowed  to  dress,  his  clothes  having  been  baked 
in  the  meantime.  One  or  two  such  baths  are  enough,  but,  as  a 
i-ule,  three  are  ordered. 

In  the  Vienna  clinics  the  patients  with  scabies  are  turned 
over  to  the  "diener,"  who  orders  them  to  strip  and  then  gives 
them  a  jar  of  Hebra's  modification  of  Wilkinson's  ointment, 
composed  of  sulphur  flowers,  15  per  cent.;  oleum  rusci,  15  per 


HYDROTHERAPY   IN   SURGICAL   AFFECTIONS  209 

cent.;  green  soap,  30  per  cent.;  prepared  chalk,  10  per  cent.; 
lard,  30  per  cent.  The  "diener"  sees  that  this  is  rubbed  all 
over  the  body  from  the  neck  down.  They  are  then  allowed  to 
dress  and  are  instructed  not  to  bathe,  and  to  rub  the  ointment 
on  once  a  day  until  the  skin  begins  to  desquamate,  which  takes 
four  or  five  days.  They  are  then  allowed  to  bathe,  and  when  the 
skin  has  all  desquamated,  which  will  be  four  or  five  days  longer, 
they  are  cured. 

FURUNCULOSIS  AND  PEMPHIGUS 

These  afTections  have  lately  been  successfully  treated  by 
means  of  hot  baths  and  hot  dry  packs,  followed  by  an  immersion 
bath  of  1  :  10,000  of  the  solution  of  mercuric  chlorid. 

The  method  depends  upon  the  ability  to  dislodge  the  staphy- 
lococci from  the  horny  layer  of  the  skin,  where  they  start  the 
abscesses.  This  is  accompHshed  by  the  vigorous  sweating  and 
the  action  of  the  bichlorid.  The  procedure  was  instituted  by 
Lewandowiski  and  adopted  on  a  large  scale  by  Reiche,  who 
applied  it  chiefly  in  the  case  of  children.^ 

Hot  wet  packs  and  affusions  are  useful  in  these  diseases. 

HYDROTHERAPY  IN  SURGICAL  AFFECTIONS 

Germany  and  Austria  are  far  in  advance  of  England  or 
America  in  the  sj^stematic  use  of  hydrotherapy.  In  the  Hydro- 
therapeutic  Institute  of  the  University  of  Berhn  thousands  of 
patients  have  been  treated  yearly  since  its  opening  in  January, 
1901 ;  100  skilled  attendants  are  employed  and  hundreds  of  phy- 
sicians from  Germany  and  other  countries  have  been  educated  in 
hydrotherapeutic  methods.  In  the  Royal  Wilhelms  Heilanstalt, 
in  Wiesbaden,  about  4000  surgical  cases  were  treated  in  1903  and 
1904.  In  a  single  year  over  40,000  baths  were  given  to  all  classes 
of  patients.  The  chief  ailments  treated  were  chronic  articular 
rheumatism,  bruises,  sprains,  fractures,  dislocations,  and  wounds. 

1  Therap.  Monatshefte,  May,  1909,  xxiii,  No.  5,  Jour.  Amer.  Med.  Assoc, 
June  12,  1909. 
14 


210  HYDROTHERAPY 

Thermal  baths  were  most  commonly  used;  i)artial  thermal  baths, 
thermal  douches,  and  fango  treatment  were  also  frequently 
employed;  cold  douches  and  steam  douches  were  used  less  fre- 
quently. Hydrotherapy  is  used  in  connection  with  massage 
and  the  Zander  apparatus. 

The  waters  employed  abroad  are  usually  only  a  little  above 
the  body  temperature.  Mineral  steam  baths,  baths  or  douches 
in  mineral  water  or  of  gaseous  waters  are  used,  and  always  in 
connection  with  the  internal  use  of  some  of  the  springs.     The 


Fig.  45. — Diagram  to  show  the  effects  of  heat  and  cold  in  lessening  the  pain  of 
inflammation.  The  diagram  represents  the  end  of  the  finger,  a  star  indicating  the 
point  of  irritation.  The  line  in  the  center  of  each  figure  represents  the  sensory 
nerve,  on  either  side  of  which  are  drawn  the  artery  and  vein,  joining  in  a  capillary 
network  at  the  tip.  At  a  the  capillary  network  around  the  seat  of  inflammation  is 
seen  to  be  much  congested;  the  nerve  filaments  are  thus  pressed  upon  and  pain  is 
felt;  b  represents  the  condition  of  the  finger  after  the  application  of  cold  to  the  arm 
or  hand.  In  consequence  of  the  contraction  of  the  afferent  arteries  the  finger 
becomes  anemic,  no  pressure  is  exerted  on  the  nerve  filaments,  and  pain  is  relieved; 
c  represents  the  finger  after  it  has  been  encased  in  a  warm  poultice;  the  capillary 
network  at  the  surface  of  the  finger  is  dilated  and  the  blood  is  thus  drawn  away 
from  the  seat  of  irritation,  and  pain,  therefore,  is  relieved  (Sir  Lauder  Brunton). 

greater  heat  capacity  of  mineral  mud  and  sand  baths  favors 
their  use. 

Many  surgical  affections  respond  to  hydrotherapy  locally 
and  generally  applied.  The  general  tonic  and  hygienic  influence 
of  bathing,  the  improved  condition  of  the  blood,  and  the  circula- 
tion and  consequent  increased  oxidation  are  the  prime  factors. 

Relative  Effect  of  Heat  and  of  Cold  in  Local  Infiamma- 
tion. — In  choosing  heat  or  cold,  one  should  take  account  of  the 
character  of  the  tissues  which  are  inflamed.     If  these  are  soft 


SPRAINS  211 

and  yielding,  the  use  of  heat  is  more  likely  to  give  relief  than  if 
the  inflammation  is  seated  in  or  under  more  unyielding  struc- 
tures. It  is  well  known  that  pain  at  the  root  of  a  tooth  or  under 
hard  fascia  is  best  relieved  by  heat.  In  his  lectures  on  the 
therapeutics  of  the  circulation  in  the  physiologic  laboratory  of 
the  University  of  London,  Sir  Lauder  Brunton  showed  this 
well  by  means  of  the  accompanying  diagram  (Fig.  45). 

DISEASES  OF  THE  BONES  AND  JOINTS 

Acute  diseases  of  the  bones  and  joints  are,  generally  speaking, 
poor  subjects  for  hydrotherapy.  In  all  these  affections  a  chronic 
process  follows  the  acute  stage;  but  treatment  in  this  manner 
affords  the  best  results. 

An  acute  infectious  osteomyelitis,  in  which  the  growing 
skeleton  and  all  its  parts  are  affected,  affords  a  conspicuous 
example.  Pus  infiltrates  the  bones,  causing  necrosis,  and  baths 
may  accomplish  great  good.  Stiffened  joints  resume  their 
former  mobility;  the  atrophied  muscles  are  afforded  a  better 
circulation  and  strength  returns  as  formerly;  but,  more  than  this, 
hydrotherapy  favors  the  separation  of  dead  bone  from  the  sur- 
rounding healthy  tissues.  For  such  cases  warm  baths  of  long 
duration  for  several  weeks  are  required. 

In  tuberculosis  of  the  bones  and  joints  preeminence  is  nat- 
urally given  to  the  influence  of  climate.  Especially  favorable 
are  marine  climates  and  second  only  to  salt  or  mud  baths  con- 
taining iodin  and  bromin.  Dr.  Fedor  Krause,  of  Berlin,  who  has 
given  a  great  deal  of  attention  to  this  subject,  attributes  to  such 
baths  a  direct  influence  on  bone  tuberculosis.^ 

SPRAINS 

One  of  the  commonest  surgical  affections  for  which  hydro- 
therapy is  applied  is  a  sprain  of  the  ankle.  Both  hot  and  cold 
applications  yield  good  results,  and  either  may  be  chosen,  depend- 
ing upon  which  is  the  most  convenient  and  which  will  prove  more 

1  BerUner  Klin.  Woch.,  Nov.  14,  1905. 


212  HYDROTHERAPY 

grateful  to  the  patient.  The  author  has  usually  employed  hot 
water  in  acute  cases.  The  swelling  and  hyperemia  arc  controlled 
by  either  hot  or  cold,  aided  further  by  the  application  of  firm  and 
systematic  pressure  and  massage. 

Hot  Applications. — When  seen  shortly  after  the  injury 
or, better,  before  the  i)hysician  has  arrived,  the  injured  foot  should 
be  placed  in  a  foot-tub  partly  filled  with  water  at  about  103°  or 
104°  F.  (39.4°  or  40°  C).  This  will  be  sufficiently  hot  for  most 
patients,  particularly  for  children  and  men;  hotter  water  may 
be  added  cautiously  until  a  temperature  of  110°  or  112°  F. 
(43,3°  or  44.4°  C.)  is  reached.  Some  patients  can  stand  higher 
temperature,  but  extreme  heat  is  not  necessary.  Water  should 
be  added  as  the  bath  loses  heat;  the  ankle  and  foot  may  be 
rubbed  or  stroked  while  in  the  water.  After  ten,  twelve,  or 
fifteen  minutes  the  limb  is  rubbed  dry  and  then  gently  massaged 
or  rubbed  with  a  little  soap  liniment.  A  good  dressing  for  the 
next  twelve  or  twenty-four  hours  consists  of  a  long  face  towel  of 
linen  folded  in  its  long  diameter  and  rolled  like  a  bandage.  This 
is  dipped  in  water  at  about  120°  F.  (48.9°  C.)  and  applied  like  a 
roller  bandage.  This  bandage  may  be  enveloped  in  a  dry  bath 
or  Turkish  towel  and  the  patient  made  comfortable  in  bed.  If 
the  pain  persist,  applications  of  water  at  110°  F.  (43.3°  C.)  may 
be  made  to  the  towel  first  applied  If  the  patient  be  not  in  bed, 
the  foot  should  be  elevated.  After  twelve  or  twenty-four  hours 
the  dressing  should  be  removed  and  a  stimulant  liniment  or  the 
milder  soap  liniment  applied,  and  the  massage  repeated. 

Surgeons  are  inclined  to  apply  the  plaster-of-Paris  dressing  at 
this  stage  or  the  adhesive  straps  advocated  by  Gibney,  Little- 
john,  and  H.  G.  Johnson.*  The  latter  uses  an  ice-bag  three  out 
of  four  hours,  applied  over  the  part,  the  limb  having  been  pre- 
viously dressed  with  adhesive  strips  and-  an  enveloping  gauze 
bandage.  After  forty-eight  hours  it  may  be  possible  and  desir- 
able for  the  patient  to  take  a  few  steps.  Each  case  has  to  be 
treated  in  accordance  with  the  character  of  the  injury,  but  the 
author  believes  that  the  greatest  dangers  are  in  attempting  to 
1  New  York  Medical  Journal,  May  19,  1906. 


SPRAINS  213 

use  the  limb  too  soon  and,  on  the  other  hand,  employing  methods 
that  immobilize  the  joint  and  prolong  the  period  of  disability. 

Cold  Applications. — ^^A^'hen  cold  water  is  chosen  at  the  start, 
or  when  the  accident  occurs  in  field  or  in  camp,  the  foot  should 
be  placed  in  a  running  stream  and  vigorous  friction  applied.  In 
foot-ball  practice  cold  water  is  the  panacea,  and  it  is  remarkable 
what  restorative  effects  it  produces  while  "time  is  called"  or 
"between  halves"  or  quarters  in  all  sorts  of  minor  accidents 
incident  to  the  game  (see  p.  215). 

Cold  may  be  applied  to  sprains  and  bruises  by  means  of  cloths 
wrung  out  of  ice-water,  by  ice-bags,  and  by  "ice  rubs." 

Dry  Heat. — In  acute  and  chronic  sprains  and  in  tenosynovitis 
great  comfort  and  benefit  are  derived  from  applications  of 
dry  heat.  In  general,  it  may  be  said  that  under  the  action  of 
heat  the  parts  enlarge  by  reason  of  the  access  of  blood ;  but  owing 
to  the  acceleration  of  the  circulation  the  absorption  of  exudates 
is  favored. 

Influence  of  Osmotic  Pressure. — Some  stress  is  laid  by 
German  writers  on  the  influence  of  the  osmotic  pressure  on  the 
size  of  the  cells.  It  is  claimed  ^  that  when  the  osmotic  pressure 
is  high,  the  cells  of  the  region  are  injured  and  swell,  resulting  in 
pain  and  inflammation.  The  application  of  hot  or  cold  water 
bandages  to  induce  reactive  hyperemia,  among  other  things 
affects  the  conditions  of  the  osmotic  pressure,  increasing  the 
centrifugal  movement  of  the  lymph,  and  with  it  sweeping  the 
products  of  inflammation  toward  the  periphery,  where  they  are 
likely  to  be  taken  up  by  the  blood  or  otherwise  rendered  innocu- 
ous. Superficial  edema  with  deep-seated  inflammation  should 
be  regarded  as  an  indication  for  inducing  this  reactive  hyper- 
emia, and  this  indication  can  be  met  by  applying  a  Priessnitz 
bandage.  It  is  also  indicated  when  the  edema  is  still  latent,  for 
the  effect  is  far  reaching. 

iH.  Schade,  Action  of  Hot  or  Cold  Water  Bandages  in  Inflammation, 
Munchener  Medizinischer  Woch.,  liv,  1907,  No.  18,  pp.  865-920. 


214  HYDROTHERAPY 

FELONS.  FURUNCLES,  AND  PHLEGMONS 

Local  hot  baths  are  usetl  in  Germany  and  Austria  for  these 
injuries.  These  baths  are  maintained  at  as  high  a  temperature 
as  can  be  borne  for  half  an  hour  to  an  hour  and  repeated  several 
times  a  day.  Sometimes  a  little  carbonate  of  soda  (^  table- 
spoonful  to  1  quart)  is  added.  Undoubtedly  these  measures 
hasten  the  natural  processes  of  repair  and  are  analogous  to  the 
methods  of  passive  hyperemia  advocated  by  Bier. 

SURGICAL  SHOCK 

Heat  is  usually  required  in  shock.  A^Hhenever  the  bodily 
temperature  falls  below  normal  and  collapse  threatens,  hot  ap- 
plications should  be  made.  If  there  are  no  dressings  or  other 
injuries  to  interfere,  apply  hot  packs  or  give  hot  baths.  The 
mere  wrapping  of  the  body  in  blankets  when  the  animal  tem- 
perature has  fallen  will  not  suffice.  The  hot  bath,  according  to 
H.  C.  Wood,  is  the  only  pyretic  remedy  that  can  be  relied  upon. 
It  should  always  be  a  full  bath,  in  as  warm  a  room  as  can  be 
procured,  and  should  be  at  a  temperature  of  about  104°  F. 
(40°  C). 

The  duration  of  the  bath  varies  with  circumstances,  but  it 
should  not  be  less  than  half  an  hour  unless  the  mouth  tempera- 
ture becomes  normal  in  less  time.  During  the  bath  the  heat  of 
the  water  should  steadily  be  increased  as  rapidly  as  it  can  be 
borne  if  the  patient  be  conscious;  if  he  be  unconscious,  until  a 
temperature  of  108°  F.  (42.2°  C.)  be  reached. 

Heat  During  and  After  Operations. — In  applying  heat 
during  or  after  surgical  operations  it  is  possible  to  produce  a 
condition  similar  to  insolation.  In  a  recent  case  of  abdominal 
section  for  fibroid  tumor,  notwithstanding  the  great  heat  of  the 
day,  the  thermometer  in  the  operating  room  registering  94°  and 
95°  F.  (34.4°  and  35°  C),  hot-water  bottles  were  hberally  used  in 
preparing  the  bed  and  were  also  placed  about  the  patient. 
The  temperature  of  the  patient  rose  to  108°  F.  (42.2°  C.)  before 
the  artificial  heat  was  removed.    Although  an  ice-cap  was  im- 


BURNS  AND   SCALDS  215 

mediately  placed  on  the  head  and  the  patient  sponged  with  al- 
cohol, the  patient  died  in  twenty-seven  hours,  probably  from 
the  overuse  of  heat.^ 

FOOTBALL  INJURIES 

These  are  not  so  common  or  so  serious  since  new  rules  were 
adopted  in  1906,  with  the  important  modifications  agreed  upon 
in  1910.  They  are  frequent  enough,  however,  to  require  the 
presence  of  surgeons,  both  in  practice  and  in  match  games  in 
the  larger  colleges.  The  commonest  accident  is  concussion  of 
the  brain;  or,  at  least,  this  was  the  commonest  accident  under  the 
old  rules  when  "mass  plays"  were  in  vogue.  Now,  in  the  expe- 
rience, at  least,  of  the  Harvard  football  squad,  dislocation  of  the 
acromial  end  of  the  clavicle  is  the  most  frequent.  Poops  are  also 
not  infrequent,  as  well  as  contusions,  sprains,  and  dislocations. 
Buckets  of  cold  water  are  kept  at  hand  to  dash  in  the  face  of  men 
receiving  concussions  and  for  use  in  cases  of  contusions  and 
sprains. 

Poops,  by  which  are  meant  ruptures  of  one  or  more  of  the 
anterior  thigh  muscles,  are  very  painful,  and  in  some  cases  are 
followed  by  an  effusion  into  the  knee-joint  and  by  synovitis. 

The  best  treatment  is  a  long-continued  soak  in  hot  water  by 
means  of  the  full  bath  or  hot  compress  to  the  entire  Hmb.  Ab- 
solute rest  is  necessary  and  in  the  early  stages  massage  should 
be  wholly  avoided. 

In  synovitis  of  the  knee-joint  a  long  hot  soak,  or  long  and  re- 
peated fomentations  or  hot  compresses  should  be  used.  These  are 
followed  by  a  heavy  bandage  to  produce  compression.  This  is 
repeated  at  bedtime,  the  knee  soaked  again,  and  the  bandage 
reapplied. 

BURNS  AND  SCALDS 

Continuous  Bath. — One  of  the  latest  and  most  successful 
methods  of  treating  extensive  burns  is  by  means  of  the  con- 
tinuous bath.  The  patient  is  immersed  in  a  tub  of  water  at 
98°  F.  (36.7°  C.)  and  a  constant  temperature  maintained.     He 

^  Jour.  Amer.  Med.  Assoc,  March  13,  1909. 


216  HYDROTHERAPY 

is  taken  out  every  day  for  the  removal  of  sloughs,  but  is  replaced 
in  the  bath  until  all  sloughing  has  ceased.  The  water  is  changed 
several  times  in  the  twenty-four  hours;  it  is  comfortable  for  the 
patient  and  obviates  the  disagreeable  odor  so  objectionable  in 
these  cases. 

In  European  hospitals  this  method  is  used  much  more  ex- 
tensively than  in  America,  but  some  of  our  institutions  are  now 
provided  with  facilities  for  the  continuous  bath. 

Dr.  Achilles  Rose  has  brought  this  bath  to  the  notice  of  the 
medical  profession  in  America  and  gives  the  following  account 
of  it: 

"  Sept.  14, 1857,  a  fire  broke  out  in  the  pyrotechnical  labora- 
tory in  Frankfort-on-the-]\Iain.  Of  20  persons  burnt,  7  had 
perished  in  the  flames  or  died  from  inhaling  obnoxious  gases. 
Among  the  13  remaining  who  were  taken  to  the  hospital 
different  degrees  of  combustion  presented  themselves.  All 
these  cases  were  treated  by  Dr.  G.  Passavant  and  all  except 
those  with  burns  on  the  head  alone  were  given  the  continuous 
warm  bath — according  to  the  extent  of  the  injury — the  partial, 
or  the  full  bath.  This  is  the  first  record  I  can  find  in  literature 
of  treatment  of  burns  by  the  continuous  warm  water  bath. 

"  We  see  Passavant  has  treated  extensive  burns  with  the  con- 
tinuous bath  in  the  year  1857  (his  first  publication  of  the  method 
appeared  in  the  year  1858),  but  Hebra  writes  in  the  AUgemeine 
Wiener  Medizinische  Zeitung,  1861,  No.  43:  'The  continuous  full 
bath  given  for  therapeutic  purposes  and  kept  up  for  days,  weeks, 
and  months  has,  as  far  as  I  am  aware,  never  been  tried  or  carried 
out  by  any  one.'  He  says  he  has  made  use  of  this  method  in 
three  cases  during  the  year  1860.  His  experience  in  the  treat- 
ment of  such  injuries  by  means  of  ointments  and  caustics  had 
been  most  unsatisfactory,  and  these  sad  experiences  gave  him  the 
idea  to  make  use  of  the  continuous  warm  bath  in  case  of  extensive 
burns.  He  does  not  mention  Passavant,  whose  article  appeared 
in  the  best-known  German  medical  journal  of  that  period,  namely, 
the  Deutsche  Clinic,  1858,  Nos.  36, 38,  and  39.  In  the  text-books 
— and  I  have  examined  a  great  many — Passavant  is  not  spoken  of 


BURNS  AND   SCALDS  217 

either,  but  all  credit  of  having  introduced  the  method  is  given  to 
Hebra. 

"Passavant  says  that  he  had  already  had  good  resultsbefore  the 
year  1857  by  using  these  baths  in  cases  of  combustion,  and  that 
he  had  been  induced  to  utilize  them  in  such  cases  on  account  of 
the  analogy  between  the  wounds  of  combustion  and  other  wounds 
in  which  he  had  found  the  bath  effective,  and  finally  because  he 
considered  that  the  drawbacks  attached  to  other  methods  of 
treatment  of  burns  could  be  avoided  by  employing  the  continuous 
warm  water  bath.  The  injured,  even  those  who  had  sustained 
extensive  burns,  suffered  at  first  comparatively  little,  but  after 
a  while,  most  violent  pain.  The  action  of  the  continuous  bath 
is  manifold.  It  gives  almost  immediate  and  even  complete  relief 
from  such  pain  and  can  be  considered  as  the  most  excellent  ano- 
dyne. Even  if  it  offered  no  other  advantages  it  would  be  of  great 
value  on  account  of  this  soothing  effect  when  the  pains  are  most 
excruciating.  Another  advantage  of  the  warm  water  treatment 
is  that  the  water  penetrates  the  burnt  tissues,  in  consequence  of 
which  they  remain  moist  and  soft.  Without  the  immersion  the 
cuticle  which  has  been  destroyed  in  its  whole  depth  would  harden 
and  form  an  impenetrable  cover  over  the  underlying  parts.  Im- 
mersed in  water,  tissues  which  have  become  gangrenous  cannot 
dry  up,  but  remain  moist.  They  detach  themselves  easily  and 
are  washed  away  after  having  become  detached.  Thus  the 
wound  is  constantly  kept  clean.  There  is  no  accumulation  of 
pus,  no  crusts  of  desiccated  wound  secretion,  and,  which  is  most 
essential,  no  dressing  is  required.  The  patient  has  not  to  suffer 
the  often  painful  procedure  of  change  of  dressing.  Langenbeck, 
who  in  the  year  1850  introduced  continuous  immersion  as  a 
method  of  treating  surgical  wounds,  characterized  it  as  the  mild- 
est method,  not  requiring  dressing,  securing  clean  wounds  in  a 
way  which  could  not  be  surpassed  by  any  other  method. 

"Concerning  further  and  most  essential  advantages  of  the  con- 
tinuous warm  bath  in  case  of  burns  we  have  to  study  the  physio- 
logic action  of  the  warm  bath  on  circulation  and  innervation  in 
general.     There  are  certainly  many  cases  which  would  prove 


218  HYDROTHERAPY 

fatal  without  the  advantage  of  this  means,  while  with  the  aid  of 
the  continuous  warm  bath  they  make  a  good  recovery.  We 
know  the  serious  effect  of  extensive  burns  on  the  nervous  system, 
and  here  the  continuous  warm  bath  must  be  considered  as  the 
best  of  all  remedies. 

"  When  a  part  of  the  body  is  i)lacod  in  warm  water,  the  nerve 
ends  of  the  skin  become  irritated.  This  irritation  is  transmitted 
to  the  vasomotor  nerves  and  is  followed  by  dilatation  of  the 
blood-vessels,  and  consequently  by  acceleration  of  the  circula- 
tion. This  accelerated  blood  circulation  facilitates  the  elimina- 
tion of  the  products  of  inflammation  and  infection,  and  with  the 
removal  of  pyrogen  substances  and  toxins  through  the  general 
circulation,  fever  will  be  reduced.  The  warm  baths  arc  a  means 
to  stimulate  metabolism,  the  principal  desideratum  when  we  have 
to  deal  with  severe  injuries  needing  great  recuperative  power." 

Roller  Bandage. — Winternitz  has  long  advocated  the  use 
of  roller  bandages,  wrung  out  of  cold  water,  in  the  treatment  of 
burns  and  ulcerative  processes.  The  stimulus  from  the  cold,  the 
steaming,  and  the  reactive  fluxion  induce  an  artificial  hyperemia, 
as  in  Bier's  technic. 

ERYSIPELAS  AND  IVY-POISONING  ' 
These  are  successfully  treated  by  a  concentrated  ice-cold  solu- 
tion of  magnesium  sulphate  apphed  to  the  affected  part,  and  kept 
moist  day  and  night.  An  ice-cap  to  the  head  and  general  spong- 
ing with  tepid  water  should  be  used  when  the  temperature  rises 
above  100°  F.  (37.8°  C). 

Facial  erysipelas  may  be  treated  also  by  compresses  wet 
with  a  solution  of  magnesium  sulphate  and  applied  at  a  tem- 
perature of  50°  to  60°  F.  (10°-ir).G°  C.)  (see  p.  220). 

BED-SORES 

These  are  occasionally  extensive  and  serious  complications 
of  spinal  injuries,  myelitis,  and  other  diseases,  producing  para- 
plegia. The  continuous  bath  not  only  relieves  further  pressure, 
but  reheves  many  of  the  painful  symptoms.  It  is  infinitely 
preferable  to  the  old-fashioned  water-bed. 


GENITO-URINARY  DISEASES 


219 


GENITO-URINARY  DISEASES 

CYSTITIS 

In  both  man  and  woman  the  modern  method  for  obstinate 
cases  involves  continuous  irrigation.  In  women  the  forming 
of  a  vesicovaginal  fistula  is  one  of  the  steps  in  the  procedure. 
In  men  bladder  drainage  in  cases  of  prostatic  disease  is  particu- 
larly offensive.  In  such  cases  the  use  of  the  continuous  bath  has 
proved  indispensable  wherever  tried. 

Cases  of  ulcer  of  the  bladder,  eczema,  vaginitis,  and  exfolia- 
tive suppurative  cystitis  have  been  treated  by  Dr.  G.  L.  Hunner, 


Fig.  46. — Showing  tub  and  truck  for  moving  it  (Hunner). 

of  Johns  Hopkins  Hospital,  with  good  results.  In  one  case  the 
patient  was  treated  with  continuous  baths  and  irrigation  of  the 
bladder  for  over  two  years.  The  bladder,  which  at  first  held  only 
as  much  as  an  Enghsh  walnut,  was  finally  able  to  retain  as  much 
as  340  cc.  The  patient  gained  in  weight  from  90  pounds  on  ad- 
mission to  135  pounds  on  discharge.* 

Six  cases  are  reported  with  good  results.  The  technic  re- 
quires a  large  movable  tub  provided  with  strips  of  canvas  about 
22  inches  wide  on  which  the  patient  rests.  The  ends  of  the  can- 
vas are  held  at  the  sides  of  the  tub  by  clips.     The  water  is  kept 

iQ.  L.  Hunner,  Jour.  Amer.  Med.  Assoc,  Dec.  21,  1907. 


220  HYDROTHERAPY 

at  about  100°F.  (37.8°  C.)  by  adding  hot  water  as  cooling 
occurs;  but  when  tlic  tub  is  protoctod  from  racUation  by  covers, 
as  in  the  iUustration,  it  is  not  troublesome.     The  treatment 


^ 


Fig.  47. — Showing  patient  in  tub,  with   supply-tank  and  constant  irrigation  tube 
leading  to  the  retention  catheter  (Hunner). 

takes  about  eight  hours  daily.  By  an  adjacent  supply-tank 
continuous  irrigation  of  the  bladder  by  means  of  a  retention 
catheter  is  possible. 

ORCHITIS,  EPIDIDYMITIS,   AND   BUBO 

These  affections  may  be  treated  by  applying  wet  compresses 
at  a  temperature  of  50°  to  G0°  F.  (10°-15.f3°  C).  Henry  Tucker* 
has  lately  advocated  the  use  of  a  saturated  solution  of  magnesium 
sulphate  for  the  compresses,  and  finds  that  pain,  swelling,  and 
tenderness  are  relieved  in  a  remarkably  short  time.  In  cases  of 
gonorrheal  origin  great  relief  was  obtained.  The  solution  should 
be  applied  on  from  fifteen  to  twenty  thicknesses  of  gauze  kept  wet 
by  adding  the  solution  every  half-hour  or  as  often  as  necessary. 
At  the  end  of  twenty-four  hours  the  gauze  is  removed  and  the 
parts  bathed  with  water,  reapplying  the  dressing  if  necessary. 
It  will  be  found  that  the  surface  is  blanched. 

1  Therapeutic  Gazette,  April  15,  1907. 


DISEASES   AMENABLE  TO  NAUHEIM   BATHS  221 

GYNECOLOGIC  AFFECTIONS 

Nearly  every  hydrotherapeutic  measure  may  find  a  place  in 
the  treatment  of  diseases  of  women.  If  it  be  desired  to  exert 
a  sedative  action  on  the  pelvic  organs,  the  warm  or  hot  full  bath 
or  a  hot  sitz-bath  at  110°  F.  (43°  C.)  may  be  chosen.  The  hot 
salt-water  bath  and  the  warm  vaginal  douche  are  distinctly 
relaxing.  If  a  tonic  effect  be  desired,  cold  water  may  be  em- 
ployed in  the  form  of  baths  and  douches.  The  full  bath,  sitz- 
bath,  salt-water  bath,  Nauheim  and  artificial  Nauheim  baths, 
sponge  bath,  half-bath,  spray  bath,  Scotch  douche,  and  very  hot 
vaginal  douches  are  all  useful. 

General  measures,  such  as  packs,  hot  and  cold;  the  drip  sheet; 
circular  douche;  jet  douche;  sea- water  bathing,  etc.,  are  obviously 
useful  in  restoring  the  general  health  and  tone  in  patients  who 
have  lost  health  and  strength  owing  to  uterine,  ovarian,  and 
vaginal  disorders. 

The  use  of  hydrotherapy  has  been  greatly  neglected  in  gyne- 
cology, especially  in  England  and  America.  Recent  works, 
however,  notably  Ashton's^  work  on  Gynecology,  and  Bandler's 
Medical  Gynecology, ^  lay  great  stress  on  the  value  of  hydro- 
therapeutic  measures. 

At  foreign  spas,  notably  Marienbad,  Elster,  Franzensbad 
Tarasp,  Plombieres,  Uriage,  Wildbad,  especial  attention  is  given 
to  diseases  of  women.  The  Nauheim  system  of  bathing  and 
exercises  is  to  be  recommended  and  the  artificial  Nauheim  baths 
may  be  used  in  a  wide  range  of  genito-urinary  diseases.  Bandler^ 
has  arranged  the  following  classification  of  diseases  amenable  to 
treatment  by  Nauheim  baths. 

DISEASES  AMENABLE  TO  NAUHEIM  BATHS 
"The  baths  are  of  value  in  certain  cases  of   insufficient 
development  of  the  genitalia  associated  with  relative  amenorrhea 
and  with  dysmenorrhea,  especially  if  comphcated  bj^  chlorotic 

1 W.  B.  Saunders  Co.,  fourth  ed.,  1909. 

2  Samuel  Wyllis  Handler,  The  Post-Graduate,  September,  1906;  Medical 
Gynecology,  W.  B.  Saunders  Co.,  second  ed.,  1909,  chap.  xxii. 


222  HYDROTHERAPY 

symptoms.  The  giving  of  iron  and  arsenic,  as  well  as  ovarin, 
is  an  atlclcd  therapeutic  measure  of  very  great  potency. 

"  Uterine  conditions  associated  with  a  lack  of  tonicity  of 
the  muscular  and  vascular  structures,  such  as  are  found,  for  in- 
stance, with  uterine  catarrhs.  The  immediate  effect  can  be 
recognized  by  the  large  amount  of  mucus  discharged  after  a  bath, 
which  result  is  produced  by  the  increased  circulation  and  in- 
creased stimulation  to  contraction  on  the  part  of  the  uterus. 
Therefore,  the  baths  are  of  great  value  in  cases  of  subinvolution 
and  in  persistent  hyperemia,  with  or  without  an  inflammatory 
etiology, 

"Cases  of  inflammatory  metritis  and  subinvolution  fibrosis 
may  be  benefited  so  long  as  no  great  interstitial  hypertrophy 
has  taken  place.  In  fact,  cases  of  chronic  induration  of  the 
uterine  muscle,  especially  such  as  are  associated  during  the  climac- 
terium with  marked  bleedings,  should  be  treated  with  care,  since 
an  increased  blood-supply  is  liable  to  produce  exacerbations  of 
hemorrhage. 

"A  large  number  of  cases  of  sterility  are  due  to  a  latent,  very 
subacute  salpingitis,  sometimes  with  and  often  without  closure 
of  the  abdominal  end  of  the  tube  by  cobweb  peritoneal  adhesions. 
Such  instances  due  to  gonococci,  in  which  the  inflammation  has 
followed  the  course  of  the  mucous  membrane  from  the  cervix  up, 
are  to  be  distinguished  from  septic  cases  due  to  streptococci  or 
staphylococci,  and  from  tubercular  cases  in  which  the  peritoneal 
inflammation  is  primary  and  the  infection  of  the  tube  secondary. 
We  know  that  cases  of  salpingitis  of  the  former  class,  in  which 
the  abdominal  ends  are  not  absolutely  closed,  are  cases  which 
may  be  cured.  That  adhesions  may  be  prevented  and  the  or- 
ganization of  adhesions  may  be  avoided  by  these  baths,  I  believe 
to  be  well  grounded  theoretically,  and  to  be  proved  practically. 
The  Nauheim  bath,  by  promoting  a  normal  pelvic  circulation,  by 
relieving  congestion,  by  toning  up  the  system  generally,  can  cure 
such  cases  of  salpingitis,  and  pregnancy  may  result.  The  at- 
tainment of  this  desired  end  is  aided  b}'  very  conservative  vaginal 
treatment  of  the  cervix,  of  cervical  catarrh,  and  of  cervical 


DISEASES   AMENABLE  TO  NAUHEIM   BATHS  223 

erosions.  Great  stress  is  to  be  laid  on  the  avoidance  of  intra- 
cervical  and  especially  intrauterine  treatment  of  any  sort. 

"  A  very  beneficial  action  is  exerted  by  the  baths  in  cases  of 
inflammation  of  the  pelvic  connective  tissue.  Cases  of 
cellulitis  in  early  stages,  particularly  such  as  occur  after  labor 
or  abortion,  are  very  much  benefited  by  the  administration  of 
the  baths.  If  the  baths  are  given  after  the  pelvic  connective 
tissue  is  contracted  and  sclerosed,  the  benefit  is  much  less 
marked.  In  all  inflammatory  conditions,  if  the  temperature 
has  been  reduced  to  the  normal,  with  or  without  operative  meas- 
ures, the  increased  blood-supply  and  the  relief  of  congestion  aid 
the  resistance  of  the  patient  in  overcoming  the  remaining  in- 
flammatory elements,  and  tend  to  restoration  to  the  normal  with 
a  minimum  amount  of  injury. 

"  An  almost  specific  action  of  the  baths  is  to  be  found  in  those 
cases  of  local  pelvic  subinvolution  and  in  cases  of  general  sub- 
involution so  frequently  associated  with  gastroptosis  and  mov- 
able kidney.  These  conditions  are  most  frequently  found  in 
women  who  have  borne  children,  but  occasionally  in  certain 
women  characterized  by  a  general  inelasticity  who  have  not  borne 
children.  The  baths  increase  the  tonicity  of  the  various  liga- 
ments related  to  these  pelvic  and  abdominal  ptoses.  The  baths 
produce  an  exhilaration  temporarily  and  an  increase  in  strength 
permanently. 

"Such  cases,  called  hysteroptosis,  are  decidedly  benefited. 
The  patients  gain  in  strength  and  weight,  the  number  of  red  blood 
cells  is  greatly  increased,  appetite  improves,  and  a  feeling  of 
strength  and  exhilaration  results,  such  as  no  treatment  can  ac- 
complish in  the  same  time.  In  addition,  the  local  symptoms 
and,  what  is  more  important,  the  idea  that  a  diseased  local  state 
exists,  disappear.  Here,  too.  the  addition  of  iron,  arsenic,  and 
ovarin  is  a  valuable  therapeutic  adjunct. 

"There  are  numerous  cases  in  which  it  is  desirable  before 
operation  to  restore  to  the  normal  the  circulation  in  the  pelvis 
and  to  reduce  to  the  greatest  possible  degree  the  amount  of 
accessory  exudation.     I  refer  to  cases  of  pyo salpinx,  and  es- 


224  HYDROTHERAPY 

pcc'iall}^  to  cases  of  salpingitis.  Here  a  course  of  baths  given 
before  the  operation  aids  permanent  convalescence  of  the  patient 
and  has  a  tendency  to  prevent  the  occurrence  of  further  ad- 
hesions. In  otlicr  cases  a  coui-se  of  batlis  administered  after 
the  operation  furthers  the  convalescence  and  aids  in  the  resorp- 
tion of  those  stui'np  exudates,  which  so  frequently  mar  the  per- 
manent valuable  results  of  the  operative  procedure. 

"An  unrecognized  but  most  valual)le  field  for  the  adminis- 
tration of  the  baths  is  found  in  the  postpartum  treatment  of 
women.  In  my  own  practice,  as  soon  as  mothers  are  able  to 
walk  about,  at  some  period  in  the  third  week,  a  course  of  these 
baths  is  given  to  aid  the  involution  of  the  pelvic  organs,  to  assist 
in  the  restoration  of  pelvic  and  general  tonicity,  to  stimulate 
the  nervous  system,  and  to  aid  the  secretory  function  of  the 
breasts.  I  am  sure  that  with  this  aid  patients  suffer  less  from 
loose  abdominal  walls,  acquired  displacements  of  the  uterus, 
hysteroptosis,  and  ph3''sical  and  mental  asthenia.  I  find  that 
the  patients  at  the  end  of  five  or  six  weeks  are  almost  restored 
to  their  normal  previous  condition  of  elasticity  and  well-being. 

"  Certain  cases  of  obesity,  and  especially  such  as  are  accom- 
panied by  a  diminution  in  their  regular  menstrual  flow,  are  bene- 
fited by  a  course  of  these  baths.  Not  infrequently  the  patients 
lose  weight,  especially  on  a  diet  rich  in  nitrogenous  elements 
and  poor  in  the  starchy  components.  Here,  again,  the  addition 
of  iron,  arsenic,  and  ovarin  aids  in  the  desired  result. 

"A  further  and  most  valuable  field  for  the  use  of  the  baths  is 
to  be  found  in  the  climacteric  period.  Here  the  nervous  ac- 
companiments of  the  "change  of  life"  are  often  a  source  of  an- 
noyance and  misery  to  the  patient  and  her  family.  In  those 
cases  not  complicated  by  climacteric  hemorrhages,  I  am  most 
enthusiastic  about  the  results  to  be  gained  by  a  course  of  Nau- 
heim  baths.  The  a.sthenic  physical  condition,  the  mental  de- 
pression, the  irritability,  the  nervousness,  and  especially  the 
sleeplessness,  are  certainly  relieved  to  a  great  extent  by  a  judi- 
cious use  of  these  carbonated  saline  baths.  If,  with  the  baths, 
a  thorough  course  of  massage  is  given,  and  if  at  the  same  time 


DISEASES   AMENABLE  TO  NAUHEIM   BATHS  225 

ovarin  is  administered,  with  or  without  iron  and  arsenic,  the 
results  in  many  instances  are  nothing  short  of  astounding. 

"Though  not  strictly  in  the  field  of  gynecolog>%  I  must  again 
mention  the  valuable  action  of  the  Nauheim  bath  in  many  cases 
of  rheumatism  and  gout.  Many  gynecologic  patients  suffer 
from  such  states,  and  have  gouty  or  rheumatic  nodules  in  various 
parts  of  the  body,  causing  severe  pain  in  various  nerves,  and 
causing  attacks  of  marked  occipital  headache  and  pain  along  the 
vertebra,  often  associated  with  mild  or  severe  attacks  of  migraine 
or  pseudomigraine.  Here,  Nauheim  baths  plus  massage  of  the 
nodules  are  often  productive  of  marked  reUef  from  the  annoyance 
of  this  diathesis." 

The  Method  of  Procedure. — "  Baths  when  begun  contain 
3  to  5  pounds  of  sea-salt,  2  to  4  ounces  of  calcium  chlorid,  and 
one-half  box  of  Triton  salts.  In  sensitive  cases  the  Triton  salts, 
which  furnish  the  carbonic  acid  gas,  are  omitted  from  the  first 
few  baths.  The  water  is  of  a  temperature  of  95°  F.  (35°  C); 
the  duration  of  the  bath  is  eight  minutes.  The  patient  lies 
quietly  in  the  bath.  At  the  expiration  of  the  stated  time  the 
body  is  dried  gently,  preferably  with  warm  towels,  and  the  pa- 
tient then  lies  down  in  bed  for  one  hour,  first  taking  a  cup  of  hot 
milk  or  weak  tea.  At  the  expiration  of  this  hour  the  patient  can 
resume  her  daily  vocation,  being  careful  to  avoid  great  exertion  of 
any  sort.  Baths  are  best  taken  in  the  morning,  at  least  two 
hours  after  the  meal.  The  baths  are  taken  three  days  in  succes- 
sion, then  comes  an  interval  day  on  which  no  bath  is  taken,  then 
three  baths  more  are  taken,  then  comes  another  interval  day, 
and  so  on,  until  about  twenty  baths  have  been  administered. 
No  baths,  of  course,  are  given  during  menstruation.  Each  set  of 
three  baths  is  made  a  little  stronger  by  the  addition  of  a  little 
more  salt,  a  Httle  more  calcium  chlorid,  and  more  of  the  Triton 
salts,  but  only  if  patients  stand  the  baths  well.  The  last  three 
to  six  baths  contain  8  to  10  pounds  of  sea-salt,  8  to  10  ounces 
of  calcium  chlorid,  one  and  a  half  boxes  of  Triton  salts.  The  tem- 
perature by  this  time  has  been  reduced  to  85°  F.(29.4°  C),  and 
in  some  instances  to  80°  F.  (26.7°  C).    The  lowering  of  the  tem- 

15 


226  HYDROTHERAPY 

perature  depends  upon  the  manner  in  which  the  patient  bears  the 
abstraction  of  heat.  No  patient  should  leave  the  bath  feel- 
ing cold  or  chilly.  The  last  baths  should  have  a  duration  of 
eighteen  to  twenty  minutes.  The  beneficial  effects  of  these  baths 
are  very  much  enhanced  by  a  subsequent  change  of  air  for  from 
two  to  four  weeks  at  an  altitude  of  1000  to  2000  feet.  In  almost 
all  cases,  and  especially  in  cardiac  cases,  the  administration  of 
digitalis  after  a  course  of  baths  produces  an  extremely  beneficial 
tonic  effect."  The  author  finds  that  the  Dr.  Zucker  carbonic 
acid  bath  is  very  satisfactory  (see  p.  313). 

Modification  of  Nauheim  Baths. — Bandler  recommends  a 
modification  of  the  general  Nauheim  baths  for  cases  in  which  it  is 
desired  to  secure  a  purely  pelvic  effect,  such  as  mild  subacute 
pelvic  inflammations.  This  consists  of  sitz-baths  containing 
enough  water  to  cover  the  pelvis  up  to  the  umbilicus  when  the 
patient  is  in  the  sitting  position.  This  bath  should  contain 
from  3  to  5  pounds  of  sea-salt  and  from  3  to  6  ounces  of  calcium 
chlorid  and  should  be  applied  at  a  temperature  of  from  95°  suc- 
cessively reduced  to  85°  F.  (3o°-29.4°  C),  lasting  for  from  ten 
to  twenty  minutes.  This  procedure  is  usually  followed  bj^  an 
improvement  in  the  pelvic  circulation  and  relief  of  congestion 
and  the  slighter  degrees  of  pain. 

SITZ-BATHS  IN  GYNECOLOGIC  AFFECTIONS 
These  may  be  given  cold,  from  50°  to  75°  F.  (10°-23.9°  C), 
or  hot,  104°  to  114°  F.  (40°-45.6°  C).  They  require  a  special 
form  of  tub  (see  p.  336),  so  that  the  patient  may  sit  in  water 
reaching  to  the  umbilicus.  A  blanket  should  be  placed  about 
the  patient  and  the  feet  should  be  kept  in  a  foot-tub  filled  with 
warm  water.  The  duration  of  the  bath  is  from  ten  to  thirty  min- 
utes. Cold  sitz-baths  at  85°  to  80°  F.  (29.5-26-8  C.)  are  best 
given  in  the  morning  or  afternoon  and  are  stimulating  to  the 
pelvic  and  abdominal  organs.  Hot  sitz-baths  are  best  taken  at 
bedtime. 


Internal  ocular  affections  227 

EYE  DISEASES 

EXTERNAL  AFFECTIONS 

In  ophthalmia  neonatorvim  cold  compresses  should  be 
used  in  connection  with  silver  salts.  In  the  early  stages,  when 
the  lids  are  tense  and  there  is  little  secretion,  small  square  com- 
presses of  patent  lint  (perfect  absorbent  lint)  are  kept  on  a  block 
of  ice  until  needed,  applying  them  every  half-minute,  day  and 
night,  for  the  first  thirty-six  or  forty-eight  hours  (see  p.  344). 

Fomentations  are  also  used  in  conjunctivitis  neonatorum, 
especially  when  corneal  complications  exist  or  the  conjunctiva 
is  covered  with  a  gray  film.  These  are  applied  with  squares  of 
antiseptic  gauze  wrung  out  of  carbolized  water  at  120°  F.  (48.9° 
C),  and  should  be  frequently  changed.  They  are  used  in  con- 
nection with  irrigation  of  the  eyelids  (see  p.  347). 

In  diphtheritic  conjunctivitis,  trachoma,  and  granular 
conjunctivitis  cold  applications  should  be  made  early  in  the 
attack. 

In  phlyctenular  conjunctivitis  hot  compresses  applied  to 
the  eye  for  five  or  ten  minutes  every  three  hours  are  recom- 
mended. 

Early  in  iritis,  compresses,  as  hot  as  can  be  borne,  are  useful 
to  relieve  pain  (see  p.  349). 

INTERNAL  OCULAR  AFFECTIONS 

Sweating  Processes. — Various  internal  ocular  affections  are 
successfully  treated  by  hydrotherapy,  especially  those  which 
produce  marked  diaphoresis.  Drugs  like  jaborandi  and  its 
alkaloid,  pilocarpin,^  have  been  used  in  the  treatment  of  vitreous 
opacities,  chronic  iridochoroiditis,  hemorrhage  into  the  vitreous 
and  retina,  toxic  neuritis,  and  detachment  of  the  retina,  with 
great  benefit.  But  it  is  in  this  class  of  cases  that  sweating 
processes,  produced  by  mechanical  means,  are  especially  ap- 

1  Weber,  Centralblatt  fiir  Klin.  Med.,  1876;  Burham,  Proceedings  of  Section 
on  Ophthalmology,  Brit.  Med.  Assoc,  August,  1897. 


228  HYDROTHERAPY 

plicablc.  Some  ophthalmologists,  such  as  Hansel!  and  Risley/ 
place  much  reliance  in  hot  packs  and  electric-light  baths. 

It  is  not  necessary  to  resort  to  hot  baths  as  a  preliminary 
measure.  There  is  danger  of  temporarily  greatly  weakening  the 
patient,  and  instances  are  cited  in  which  patients  bathed  at  a 
temperature  of  10(3°  or  110°  F.  (41.1°  or  43.3°  C.)  have  lost  con- 
sciousness for  a  few  moments  at  the  conclusion  of  the  bath. 
The  method  which  Hansell  strongly  advocates  is  as  follows : 

Hansen's  Method. — A  rubber  sheet  covers  the  mattress  on 
which  the  patient  lies  enveloped  in  three  thick  blankets.  On 
each  side,  extending  from  the  feet  to  the  shoulders  and  as  close 
to  the  skin  as  the  heat  will  permit,  are  placed  hot-water  bags  or 
bottles.  A  cup  of  hot  fluid,  preferably  tea,  is  drunk.  The  sweat- 
ing commences  almost  at  once,  and,  by  renewing  the  hot-water 
bags  or  bottles,  may  be  continued  for  the  desired  time.  A  glass 
of  ice-water,  one-half  hour  after  the  process  has  commenced, 
will  serve  to  stimulate  the  sweat  glands  and  increase  perspira- 
tion. During  the  entire  period  an  ice-cap  or  a  towel  frequently 
wrung  out  of  cold  water  should  be  placed  about  the  head  and 
forehead.  The  duration  of  the  pack  should  not  exceed  an  hour 
and  a  half;  longer  than  this  is  liable  to  enervate  the  patient 
and  detract  from  the  value  of  the  treatment.  At  its  conclusion 
the  body  should  be  well  dried  and  rubbed  with  alcohol;  the 
patient  dressed  with  warm  dry  night  clothing,  and  placed  in 
bed  with  warm  dry  sheets  and  blankets,  where  he  experiences 
a  feeling  of  rest  and  relaxation. 

The  most  convenient  hour  for  the  treatment  is  in  the  early 
afternoon,  the  patient  remaining  in  bed  until  the  next  morning, 
when  he  may  dress,  and,  if  the  weather  be  suitable  and  other  cir- 
cumstances permit,  he  may  take  exercise  out  of  doors. 

Risley's  Method. — This  involves  the  use  of  an  electric-hght 
bulb  of  24-  or  32-candlepower,  which  is  hung  underneath  the  top 
of  a  cage  enclosing  the  patient.  Air  is  prevented  from  entering 
the  cage  by  blankets  and  other  covering,  only  the  head  of  the 

*  See  article  by  Howard  F.  Hansell,  Pennsylvania  Medical  Journal,  1907, 
pp.  886-890. 


INTERNAL  OCULAR  AFFECTIONS  229 

patient  being  exposed.  Electric  pads  enclosed  in  a  flannel 
covering  and  provided  with  a  thermostat  may  be  used  instead  of 
the  electric  bulb,  and,  being  automatically  regulated,  there  is 
no  danger  of  exceeding  a  given  degree  of  heat. 

The  numher  of  sweats  and  their  frequency  depend  upon  the 
severity  and  chronicity  of  the  disease  and  upon  the  physical  qual- 
ities of  the  patient.  In  acute  inflammation  a  week  or  ten  days 
may  be  sufficient;  in  chronic  inflammations  they  may  be  contin- 
ued for  three  weeks,  particularly  in  corpulent  subjects. 

The  duration  cannot  be  accurately  stated  beforehand.  By 
noting  the  general  and  local  effect  and  especiall}-  the  body  tem- 
perature the  physician  is  guided  as  to  his  course.  It  will  prob- 
ably be  found  that  at  the  conclusion  of  the  bath  the  body  tem- 
perature has  risen  to  102°  or  103°  F.  (38.9°  or  39.5°  C),  with  a 
corresponding  acceleration  of  the  pulse.  Two  or  three  hours 
later  both  should  have  retmiied  to  normal.  Delayed  or  a  sub- 
normal temperature  indicates  physical  weakness,  and  before  the 
next  bath  strychnin  should  be  given  hypodermically.  If,  in 
spite  of  the  stryclinin  or  other  stimulant,  the  temperature  remain 
high,  the  baths  should  be  interrupted  or  altogether  discontinued. 

Suitable  Cases. — The  class  of  cases  suitable  for  the  hydrothera- 
peutic  methods  above  described  includes  inflammation  of  the 
sclerocornea,  of  the  uveal  coat,  of  the  chorioretina,  and  of  the 
optic  nerve.  The  treatment  is  most  valuable,  according  to  Han- 
sell,  in  chronic  inflammation  associated  with  exudation  in  large 
amount  of  the  uveal  coat,  with  secondary  involvement  of  the 
tissues  immediately  adjacent.  After  the  stage  of  atrophy  and 
connective-tissue  change,  notliing  may  be  hoped  for.  Even  after 
the  ophthalmoscope  indicates  that  exudation  has  given  place 
entirely  to  connective  tissue,  improvement  may  yet  take  place. 

In  alcohol  and  tobacco  amblyopia  the  method  of  baths  and 
packs  associated  with  the  use  of  strychnin  are  of  the  greatest 
value,  especially  if  treatment  be  instituted  before  the  stage  of 
atrophy  of  the  fibers  of  the  optic  nerve. 

In  glaucoma  the  high  vascular  pressure  calls  for  a-  tranquil 
environment.     Hot  foot-baths  of  ten  minutes'  duration,  with 


230  HYDROTHERAPY 

the  addition  of  salt  or  mustard,  may  prove  useful.  Full  hot  baths 
or  sitz-baths  are  likely  to  aggravate  the  condition,  but  if  tepid 
water  be  used  at  85°  to  90°  F.  (29.4°-32.2°  C.)  there  will  be  no 
injurious  efTect. 

The  following  cases  cited  by  Hansell  are  typic  of  the  value 
of  hydrotherapy  in  ocular  affections : 

Case  1. — Mrs.  X.  One  year  previous  to  treatment  she  became  innocently 
infected  with  syphiUs.  Tlie  usual  seconilarj'  symptoms  followed  and  she  was 
treated  witli  mercury  and  potassium  iodid.  Four  weeks  before  consulting 
Dr.  Hansell  iritlocyclitis  had  developed  in  the  right,  and  two  weeks  before  the 
eame  condition  tieveloped  in  the  left  eye.  Vision  at  the  time  of  examination 
was:  R.,  counting  fingers  at  one  foot.  L.,  -^^ff.  Total  posterior  synechisB 
and  vitreous  opacities  in  both.  No  view  of  the  fundus  of  either  eye  could  be 
obtained.  One  week  after  commencing  the  sweats  and  mercurial  inunctions 
the  synecliiae  were  almost  all  broken  off,  the  vitreous  had  regained,  to  a  large 
extent,  its  transparency,  and  vision  had  improved  to  f  J  in  each  eye.  After 
several  weeks  tlie  jiaticnt  was  able  to  read  and  could  see  practically  as  well  as 
ever.  This  patient  Iiad  seven  sweats,  each  one  and  a  iialf  hours  in  duration, 
and  mercurial  invinctions  carried  to  the  point  of  saturation. 

Case  2. — A  clerk,  aged  twenty-six.  Four  montiis  before  he  came  under 
obser\'ation  he  had  fever  with  pain  in  the  abdomen  and  back  and  some  bladder 
trouble,  the  nature  of  which  was  not  ascertained.  He  recovered  in  a  few  days, 
and  during  convalescence  vision  became  affected  to  such  a  degree  that  he  made 
his  way  with  difficulty.  He  complained  of  headache  and  diplopia  before  and 
during  his  illness.  Vision  5^^;  the  fields  were  concentrically  contracted  for 
form  and  almost  entirely  lost  for  colors,  recognizing  blue  only  at  the  fixation- 
point  with  the  right  eye.  The  diagnosis  was  acute  double  optic  neuritis.  The 
patient  was  given  mercurial  inunctions  and  sweats  for  nine  consecutive  days. 
Ten  days  after  beginning  treatment  vision  had  improved  to  ^g,  the  fields  had 
widened  nearly  to  the  normal  limits^  all  colors  were  recognized,  and  the  optic 
nerve  and  adjacent  retina  were  free  from  edema. 

INDUCED  PHENOMENA  DURING  A  COURSE  OF 
HYDROTHERAPY 

It  should  not  be  forgotten  that  latent  foci  of  infection  may 
be  aroused  to  renewed  or  primary  activity  during  a  course  of 
hydrotherapy.  This  is  probably  more  liable  to  occur  when  the 
patient  is  under  treatment  for  some  surgical  condition.  An  auto- 
inoculation  or  reinoculation  may  be  brought  about  by  douches 
and  packs  and  a  more  or  less  severe  reaction  ensue.*     Kraus  has 

^  See  p.  120,  article  on  Rheumatism. 


INDUCED   PHENOMENA   DURING   COURSE   OF  HYDROTHERAPY  231 

applied  the  term  "  Provokationserscheinungen "  to  phenomena 
of  this  type. 

For  example,  in  a  patient  who  was  being  treated  with  local 
douches  and  packs  to  relieve  chronic  recurring  pain  in  the  peri- 
neal region,  with  other  measures  for  an  old  chronic  urethritis, 
signs  of  small  abscess  in  the  prostate  became  apparent  on  the 
fourth  day  of  treatment. 

Kraus  has  noticed  that  patients  sometimes  complain  of  tooth- 
ache after  hydrotherapeutic  measures.  This  is  not  neuralgia, 
but  merely  the  flaring  up  of  some  latent  carious  process.  It  is 
obviously  desirable  to  have  the  teeth  put  in  order  before  under- 
taking the  various  ''cures,"  especially  when  these  involve  long 
journeys. 

In  all  cases  of  pyosalpinx  or  gonorrheal  genital  processes 
there  is  the  possibility  that  these  may  take  on  an  acute  activity. 
In  such  cases,  as  well  as  in  gonorrheal  joints  and  other  forms  of 
arthritis,  one  should  endeavor  to  obtain  that  degree  of  hyperemia 
which  promotes  the  absorption  of  morbid  products.  A  happy 
mean  between  too  little  and  too  much  is  desirable.  In  mediis 
tutissimus  ibis.  Those  who  have  had  a  large  experience  in  the 
treatment  of  gout  and  rheumatism  are  familiar  with  these  un- 
pleasant events.  To  the  patient  it  is  always  a  disheartening 
and  trying  period,  to  which  he  is  rarely  submissive. 

A  few  days  of  rest,  however,  usually  restores  his  equilibrium. 
As  Kraus  remarks:  "The  tissues  must  be  coaxed  into  proper 
assimilation."  Experience  brings  skill  in  the  appHcation  of  the 
measures,  and  this  is  the  main  point,  and  not  so  much  the  special 
technic. 

The  disturbance  of  the  vasomotor  reaction  to  the  nerve  stim- 
ulus is  liable  to  persist  longer  in  nervous  persons  with  a  tendency 
to  arteriosclerosis.  There  may  be  nervous  crises,  vertigo,  or 
buzzing  in  the  ears,  but  these  are  usually  transient  and,  although 
the  arteriosclerosis  may  not  be  cured,  the  symptoms  may  be 
abated.  The  aim  should  be  to  adapt  the  work  of  the  tissues  to 
the  given  disturbances. 


TECHNIC  OF   HYDROTHERAPY 


"  If  to  do  were  as  easy  as  to  know  wliat  were  good  to 
do,  chapels  had  been  churches,  and  the  poor  men's  cottages 
princes'  palaces." — Merchant  of  Venice,  i,  2. 


Centigrade.       Fahrenheit. 
260°     500°.. 


204.4° 400° 


148.7' 


.300° 


115.6° 240° 


100° 


.212° 


93.3° 200°. 

82.2° 180°. 

54.4° 130°. 

48.9° 120°. 

46.1° 11.-)°. 

40.6° 105°. 

37.8° 100°. 

32.2° 90°. 

23.9° 75°. 

22.2°  72° 

15.6° 60°. 

10°     50°. 

4.4° 40°. 


.  Radiant  heat. 


.Radiant  Heat  Bath,  maximum  bear- 
able for  full  body  bath. 


.  Radiant  Heat  Bath,  comfortable. 

.Very  Hot  Turkish  Bath. 

.  "Water  boils. 

. "  Calidarium"— Turkish  Bath. 
. "  Tepidarium"— Turkish  Bath. 
.  Fango  Mud  Bath,  bearable. 
.Vapor  Bath,  unbearable. 
.  Fango  Mud  Bath,  comfortable. 


.Hot 

.  Warm 

.Tepid 

.Cool 

.  Sea  Baths 

a  it 

.Cold 

.Very  Cold   J 


Water  Baths. 


Fig.  48. — Chart  showing  thermometric  equivalents  (Luke). 


232 


EFFECTS  OF  EXTERNAL  APPLICATIONS  OF  HEAT  AND  COLD  233 


STANDARDS  OF  TEMPERATURE,  IN  DEGREES  FAHRENHEIT,  USUALLY 
ACCEPTED  IN  HYDROTHERAPY 


Bath. 

Water. 

Vapor.                              Air. 

Cold.... 

.40°  to  65°  F, 
(4.4°-18.3°  C). 

Cool  .... 

.65°  to  75°  F. 
(18.3°-23.8  C). 

Tepid.  .  . 

.85°  to  95°  F. 
(29.4°-35°  C). 

Warm . . . 

.95°  to  100°  F. 

100°  to  115°  F.     110°  to  120°  F. 

(35°-37.7C.). 

(37.7°-46. 1°  C.) .  (43.3°-48.8°  C.) 

Hot 

.100° to  110°  F. 

115°  to  140°  F.     120°  to  180°  F. 

(37.7°-43.3°C.). 

(46.1°-60°  C).      (48.8°-82.2  C). 

Very  hot 

.110°-120°  F. 
(43.3°-48.8°  C), 

or  more. 

Bath  Thermometer. — The  most  nnportant 
piece  of  apparatus  in  hydrotherapy  is  the  bath 
thermometer.  The  trouble  with  most  bathing  at- 
tendants is  that  they  do  not  rely  sufficiently  on  a 
good  instrument,  easily  read.  It  takes  young  eyes 
and  a  good  light  to  read  the  scale  on  the  cheap 
bathing  thermometers  in  common  use. 

EFFECTS  OF   EXTERNAL   APPLICATIONS 
OF   HEAT  AND  COLD 

It  is  generally  believed  and  stated  that  heat 
can  be  conveyed  to  or  abstracted  from  the  deeper 
structures  of  the  human  body  by  external  applica- 
tions. This  is  probably  true  onh^  to  a  very  limited 
and  comparatively  superficial  extent.  Schultze  has 
claimed  that  an  ice-compress  can  reduce  the  temperature 
3.5° F.  (1.9°  C.)  nearly  1  inch  below  the  surface,  and  7°  F.  (3.8° 
C.)  on  the  inner  surface  of  the  thorax.  Esmarch  undertook 
to  measure  the  influence  of  cotd  on  the  body.  He  inserted  a 
thermometer  into  a  carious  sinus  in  the  leg  and  applied  an  ice- 
bag  for  nine  hours  and  noted  a  fall  of  50°  F.  (10°  C).  Similar 
results  were  obtained  by  immersion  and  also  by  irrigation  with 


Fig.  49.— Bath 
thermometer. 


234  HYDROTHERAPY 

cold  water.  Schweinburg  and  Schlikoff  claim  a  lowering  of  tem- 
perature when  ice  is  placed  on  the  surface  and  measurements 
are  taken  in  the  mouth,  the  vagina,  the  bowel,  and  the  pleural 
cavity.  When  ice  was  placed  on  one  side  of  the  thorax  a  lower- 
ing of  the  temperature  in  the  opposite  side  of  the  thorax,  amount- 
ing to  6.7 °  F.  (3.7  °  C.) ,  was  noted.  Winternitz,  Silva,  Heitel,  and 
Kowalski  have  recorded  similar  experiments,  which  show  an 
undeniable  temperature  effect  on  the  deeper  structures  when 
superficially  applied.' 

Dr.  W.  Oilman  Thompson,  of  New  York,  in  some  un- 
published experiments  privately  communicated  to  the  author, 
arrived  at  very  different  results.  He  passed  some  long-stemmed 
thermometers  into  thoracic  sinuses  of  patients  who  had  been 
operated  upon  for  empyema  and  also  into  the  female  bladder. 
Very  hot  poultices  were  then  applied  to  the  external  surface, 
followed  by  ice-bags.  The  thermometers  were  never  affected 
more  than  .125°  F.  (.0075°  C).  Similar  tests  were  made  within 
the  cheek,  with  the  same  negative  result.  Dr.  Thompson  excised 
ribs  of  dogs  and  fitted  in  glass  windows  with  a  double  flange, 
so  that  the  pink  lung  played  against  the  window.  Poultices 
applied  to  the  external  surface  produced  no  temperature  effect, 
although  in  all  similar  experiments  on  the  cadaver  the  tempera- 
ture was  decidedly  altered  at  once.  In  the  latter  case  there  is 
no  layer  of  constantly  moving  blood  beneath  the  poultices  or 
the  ice  to  quickly  convey  away  the  thermal  units. 

The  obvious  reason  of  the  failure  to  influence  the  deeper 
structures  of  the  human  body  is  that  the  small  amount  of  heat 
units  contained  in  any  ice-bag  or  poultice  is  ridiculously  small 
in  comparison  with  the  total  units  in  the  body.  For  this  reason 
Dr.  Baruch  is  opposed  to  the  common  practice  of  applying  an 
ice-bag  to  the  abdomen  in  case  of  hemorrhage  occurring  in 
typhoid  fever. 

Dr.  Thompson  points  out  that  the  bronchial  and  pulmonary 
vessels  spring  from  such  different  sources  from  those  supplying 

1  Schweinburg,  Hanflbuch  der  AUgemeinen  und  Speciellen  Hydrotherapie, 
Wiesbaden,  1904,  pp.  16,  17. 


EFFECTS   OF   EXTERNAL   APPLICATIONS   OF   HEAT   AND    COLD    235 

the  external  thoracic  wall  that  there  is  no  reason  why  they  should 
be  affected. 

The  fact  that  these  applications  relieve  pain  depends  on 
an  entirely  different  modus  operandi.  Neither  should  it  be  in- 
ferred that  in  pneumonia,  for  instance,  there  is  no  beneficial 
effect,  notwithstanding  that  the  external  applications  cannot 
reach  the  deep  inflammation  (see  p.  101).  Of  course,  the  less 
vascular  the  parts  the  more  appreciable  will  be  the  effects. 

In  applying  water  therapeutically  to  the  body,  mention 
will  be  made  of  some  of  the  principal  measures  shown  by  ex- 


Fig.  50. — Clow  metal  pack  table  and  requisites. 

perience  to  be  rehable.  Acknowledgment  is  made  to  Professors 
Winternitz,  Strasser,  Baruch,  Schweinburg,  Jurgensen,  of  Kiel, 
Buxbaum,  Brand,  J.  C.  Wilson,  Luke,  Pope,  Wright,  and  others, 
who  have  done  so  much  to  systematize  the  science  and  practice 
of  hydrotherapy.  The  cooling  or  heat-abstracting  measures 
will  be  considered  first,  and  afterward  the  local  and  general 
applications  of  heat  will  be  described.  Many  of  these  procedures 
are  carried  out  while  the  patient  is  reclining  in  bed,  and  it  is  very 
convenient  and  much  more  sanitary  to  have  a  narrow  metallic 


236 


HYDROTHERAPY 


bed  for  this  purpose.     A  special  bed,  rendered  perfectly  safe  by 
a  strong  spring,  has  been  designed  by  Dr.  Rebekah  B.  \\'right.' 


rig.  ol. —  l  lif  jiack  j)rii)arf'd. 


.  '  ^  ■  •  Vj '  -y  r  /ri:^i 


Fig.  52. — Application  of  the  cold  pack  (pressing  the  sheet  between  the  patient's 
arm  and  body)  (Stoney). 

It  is  made  of  steel  tubing  white  enamel,  30  inches  high,  6  feet 
long,  and  22^  inches  wide.     In  hospital  or  sanitarium  practice 

*  This  bed  is  made  by  the  Clow  Company,  Chicago 


THE    EVAPORATION   BATH  237 

it  is  sometimes  necessary  to  restrain   a   patient,  and  for  this 
reason  the  width  of  the  bed  is  an  important  consideration. 

BATHS 

THE  COOLING  WET  SHEET  PACK 

A  Hnen  sheet,  saturated  in  water  at  70°  F.  (21.1°  C),  should 
be  wrung  out  slightly  and  wrapped  about  the  patient,  taking 
care  to  apply  it  closely  to  the  body  and  around  each  limb  and 
snugly  about  the  neck.  The  patient  may  be  lightly  covered. 
In  a  few  minutes,  as  the  sheet  warms,  a  second  sheet,  similarly 
prepared,  is  applied  in  place  of  the  first  one,  and  so  on  until 
five  or  six  applications  have  been  made  at  intervals  of  about 
five  minutes.  Friction  with  the  hand  outside  the  sheet  pro- 
motes cutaneous  circulation,  and  the  temperature  of  the  febrile 
patient  may  fall  1°  F.  (.54°  C.)  or  more.  Friction  increases 
the  heat  loss  about  95  per  cent.,  and  should  be  used  after  all 
cold  applications. 

This  pack  is  modified  by  opening  up  the  sheet  and  sprinkling 
the  body  and  the  sheet  with  a  sprinkling-can  holding  water  at 
40°  to  45°  F.  (4.4°-7.2°  C),  allowing  the  patient  to  turn  slightly 
to  receive  it  on  both  sides.  Provision  should  be  made  to  protect 
the  bed  and  drain  the  surplus  water. 

THE  EVAPORATION  BATH 

Place  a  mackintosh  and  blanket  under  the  patient.  Cover 
the  patient,  both  extremities  and  trunk,  with  one  thickness  of 
gauze  moistened  in  water  at  115°  F.  (46.1  °  C).  Have  the  gauze 
fit  the  skin  snugly.  Fan  the  patient  with  a  palm-leaf  fan  and 
moisten  the  gauze,  as  evaporation  takes  place,  with  the  water 
still  maintained  at  115°  F.  (46.1°  C).  One  pint  of  water  should 
be  evaporated  in  fifteen  minutes.  A  hot-water  bag  is  placed  at 
the  feet  and  a  compress  on  the  forehead. 

To  keep  the  water  at  115°  F.  (46.1°  C.)  the  basin  should 
be  placed  in  a  larger  one  containing  water  of  a  higher  tem- 
perature. 


238  HYDROTHEFiAPY 

Cold  applications  in  the  absence  of  ice  or  cold  water  may  be 
obtained  by  the  use  of  nitrate  of  ammonium.  To  1  quart  of 
water  add  ^  pound  of  the  nitrate.  If  the  water  used  has  a 
temperature  of  70°  F.  (21.1°  C.)  it  will  soon  lose  nearly  30°  F. 
(16.2°  C.)  as  the  salt  passes  from  the  solid  to  the  liquid  state. 
This  principle  is  utilized  in  the  manufacture  of  artificial  ice. 

THE  COLD  BATH 

For  fairly  vigorous  persons  the  best  time  for  the  cold  bath 
is  before  breakfast.  Weak  or  delicate  persons  may  take  it  in 
the  forenoon.  Chill,  languor,  or  drowsiness  coming  on  after 
cold  baths  are  countcrindications  to  their  continuance;  tepid 
baths  are  then  to  be  substituted.  As  stated  above,  vigorous 
friction  should  always  follow  the  use  of  cold. 

The  water  of  the  cold  bath  is  usually  drawn  in  a  tub  from  the 
pubUc  supply,  and  varies,  according  to  the  season,  from  40°  to 
70°  F.  (4.4°-21°  C).  The  cold  bath  is  the  favorite  one  of  the 
Anglo-Saxon  race.  AH  are  familiar  with  the  determination 
with  which  the  Englishman,  wherever  he  is,  ensures  his  morning 
cold  bath,  and  undoubtedly  it  has  an  influence  in  promoting 
his  vigor  and  his  well-knowTi  appearance  of  health.  It  is  a 
rather  curious  fact,  however,  that  the  English,  while  devoted 
to  bathing  as  a  hygienic  measure,  have  not  shown  a  corresponding 
devotion  to  hydrotherapy  as  a  science  and  a  valuable  department 
of  therapeutics. 

Cold  plunge  baths  and  cold  full  baths  belong  to  the  same 
category,  and  acco  plish  very  much  the  same  purpose,  differ- 
ing very  little  unless  in  the  amount  of  water  used  and  the  extent 
of  immersion. 

The  plunge  bath,  as  usually  understood,  is  nothing  more 
than  the  morning  dip  in  the  tub  about  half-filled  with  cold 
water,  which  may  range  from  4.^°  to  70°  F.  (72°-21.1°  C). 
The  body  is  vigorously  rubbed  while  in  the  bath,  and  water  is 
carried  over  the  head  and  shoulders  by  a  large  bathing  sponge. 
The  whole  body  is  quickly  rubbed  with  the  hands,  the  bather 
sitting  up.     They  both  may  occui)y  fi'om  half  a  minute  to  three 


THE    COLD    BATH  239 

or  four  minutes,  according  to  circumstances  and  the  relish 
which  the  bather  has  for  cold  water.  If  a  pool  be  at  hand, 
the  plunge  may  be  had  in  its  full  significance.  After  a  few 
seconds  in  the  plunge  the  bather  emerges  for  a  quick  rub  with 
coarse  Turkish  towels  and  quickly  dresses.  A  feeling  of  in- 
vigoration  is  generally  experienced. 

This  is  the  sort  of  bath  the  writer  has  taken  for  many  years, 
and  he  would  not  exchange  it  for  any  other  bath  mentioned  in 
this  book.  Nevertheless,  he  by  no  means  approves  of  it  for 
everybody.  Dr.  Norman  Bridge  is  equally  enthusiastic  about 
the  hot  morning  bath,  and  thinks  it  absurd  that  the  average 
man,  sick  or  well,  should  enjoy  getting  out  of  a  warm  bed  and 
plunging  into  a  tub  of  cold  water. 

According  to  Dr.  Bridge,  "it  is  in  the  popular  mind,  among 
many  of  the  more  fastidious  of  us,  that  a  daily  bath,  or  one 
nearly  every  day,  is  necessary  for  health.  That  venerable 
error  which  reads,  '  cleanliness  is  next  to  godliness '  has  become 
part  of  the  religion  of  a  great  number  of  people.  Some  kind 
of  a  bath  must,  they  think,  be  taken,  and  the  only  one  that  is 
really  pleasant,  the  warm  and  hot  bath,  is  forbidden  by  lay 
opinion,  and  to  a  large  extent  by  professional  opinion  also,  as 
being  dangerous  when  taken  in  the  morning,  and  so  the  cold 
seems  inevitable.  The  hot  bath  is  more  agreeable  to  nearly 
everybody  than  the  cold,  but  we  have  been  taught  for  genera- 
tions by  putative  hygienists,  by  books,  professional  and  other- 
wise, by  many  thoughtful  physicians,  and  a  little,  it  may  be, 
by  an  ethical  fetish  inherited  from  some  severe  religious  past, 
that  whatever  is  pleasant  must  be  in  some  measure  a  sin — ^that 
a  hot  bath  invites  cold  catching,  and  is,  therefore,  positively 
dangerous,  unless  taken  just  before  going  to  bed,  or  unless  it  is 
ended  by  a  douche  of  cold  water  or  by  a  cold  plunge.  The 
theory  that  has  gained  currency  is  that  the  heat  of  the  bath 
'opens  the  pores'  and  leads  to  cold  catching  or  some  other  peril, 
unless  the  'pores'  are  shut  up  by  the  cold  dash  taken  at  the 
end  of  the  bath.  So  it  has  come  to  be  a  part  of  the  very  positive 
directions  generally  given  for  a  warm  or  hot  bath,  especially 


240  HYDROTHERAPY 

if  taken  in  the  morning  or  before  going  out  into  the  weather, 
that  the  end  event  of  it  shall  be  this  same  cold  dash."  ^ 

Of  course,  the  propriety  of  cold  morning  plunges  varies  wholly 
with  the  individual,  his  powers  of  reaction,  his  position  in  life, 
and  the  climate  in  which  he  lives.  What  is  best  for  a  man  in 
Boston  or  Montreal  may  be  wholly  different  for  a  man  in  New 
Orleans  or  Southern  California.  A  man  who  leaves  his  house 
at  9  or  10  o'clock  in  the  morning  can  do  many  things  unsuited 
for  the  man  whose  ''morning's  at  seven."  .It  is  beheved  that 
better  powers  of  endurance  are  developed  by  the  cold  morning 
bath,  and  that,  used  with  judgment,  a  process  of  hardening  en- 
sues which  fortifies  the  system  against  surrounding  dangers. 

The  morning  dip  in  cold  water  has  a  tonic  influence  on  flabby 
abdominal  muscles,  and  is  advised  for  the  relief  of  sluggishness  of 
the  gastro-intestinal  tract,  defective  nutrition,  obesity,  and 
autointoxication.  It  corrects  mental  torpor,  lassitude,  head- 
ache, and  listlessnoss.- 

Cold  full  baths,  oO^to  60°F.  (10°-15.6='  C),  should  last  for 
only  a  minute  or  less;  if  from  60°  to  70°  F.  (15.6°-21.1°  C), 
they  may  last  for  a  little  longer.  A  large  tub  is  required,  so 
that  the  entire  body  can  be  submerged  up  to  the  neck.  These 
baths  produce  a  tonic  effect,  deepen  respiration,  and  favor  a 
better  ventilation  of  the  lungs,  just  as  in  the  case  of  plunge 
baths.  The  appetite  is  sharpened,  digestion  improved,  peris- 
talsis is  increased,  and  constipation  prevented  or  relieved. 
Short  stimulating  baths  of  this  type  tend  to  correct  enteroptosis, 
dilatation  of  the  bowel,  and  intestinal  intoxication.  One  reason 
why  women  suffer  from  habitual  constipation  much  more  com- 
monly than  men  is  possibly  due  to  the  greater  popularity  of 
the  cold  morning  bath  among  men,  whereas  women  favor  the 
more  relaxing  tepid  bath. 

Counter  indications. — Cold  and  cool  full  })aths  are  counter- 
indicated  in  spastic  and  mechanical  constipation,  acute  inflam- 

^  Trans.  American  Climatological  Association,  1906. 

-  For  a  discussion  of  baths  for  the  relief  of  constipation  see  Constipation 
and  Intestinal  Obstruction,  chap,  xxii.,  by  Samuel  G.  Gant,  M.  D.,  1909. 


THE    COLD    BATH 


241 


matory  affections,  like  appendicitis,  peritonitis,  and  gastritis, 
in  pronounced  anemia,  and  during  gestation  (Gant).  It  is  also 
counterindicated  in  advanced  life  and  at  any  age  when  arterio- 
sclerosis exists.  Cardiac  weakness,  emphysema,  and  bronchitis 
are  better  treated  by  hot  sponge  baths. 

Sir  J.  Floyer,  who  wrote  a  notable  treatise  on  hydrotherap}'' 
two  hundred  years  ago,  was  a  strong  advocate  of  the  cold  bath, 
but  it  is  noteworthy  that  on  the  title  page  of  his  first  edition  he 
added,  the  words,  "proving  that  the  best  cures  done  by  cold 


?^^iy^^yM.^d4fe^^ :A 


Fig.  55. — Janeway's  bed  lift. 

baths  are  lately  observed  to  arise  from  the  temperate  use  of  hot 
baths  first."  He  wisely  recognized  that  warming  procedures 
render  the  subsequent  use  of  the  cold  bath  safer  and  more 
effective.  An  exception  to  this  general  principle  is,  of  course, 
the  Brand  bath  in  typhoid  fever. 

Bed  Lift. — A  helpless  patient,  or  one  whose  great  weight 

or  mental  condition  presents  difficulties,  may  be  removed  from 

the  bed  to  the  tub  and  back  again  by  means  of  a  bed  lift.     The 

best  device  is  that  of  Dr.  H.  H.  Janeway.^     It  has  the  advantage 

1  Journal  Amer.  Med.  Assoc,  Oct.  6,  1906,  pp.  1093,  1094. 

16 


242  HYDROTHERAPY 

of  lifting  tlie  patient  directly  from  the  bed  into  the  tub  with 


Fig.  54. — .Jancwa3''s  bed  lift. 


Fig.  .5.3. — Janevvay's  bed  lift. 


perfect  safety  and  with  little  exertion  on  the  part  of  the  nurse. 
It  can  be  operated  by  one  person. 


THE   SO-CALLED    "  HALF-BATH  "    OF   PRIESSNITZ  243 

Four  stout,  broad  bands  of  webbing,  with  triangular  steel 
attachments  at  both  ends,  are  placed  under  the  head,  the  thorax, 
the  pelvis,  and  the  legs.  The  steel  bar  (Fig.  53)  is  then  lowered 
by  means  of  stout  rope  and  pulleys  connected  with  a  substantial 
steel  frame,  set  in  cross-shaped  wooden  base  and  operated  by  a 
windlass.  The  patient  is  then  Hfted  bodily  from  the  bed  (Fig. 
54).  It  is  then  a  matter  of  only  a  few  minutes  to  remove  the 
bed  for  renovation  and  to  place  the  movable  tub  in  position. 
By  using  extra  bands  and  varying  their  position  any  part  of 
the  back  can  be  exposed  to  the  bath  or  given  special  dressings. 
By  depressing  the  bar  above  the  feet  the  head  need  not  be  allowed 
to  come  in  contact  with  the  water.  In  cases  where  one  nurse 
only  is  on  duty,  bathing  becomes  perfectly  practicable  if  this 
apparatus  be  at  hand.^ 

THE  SO-CALLED  "HALF-BATH"  OF  PRIESSNITZ 

This  is  really  a  shallow  bath,  the  water  reaching  to  the  um- 
bihcus,  but  its  application  involves  the  whole  surface  of  the  body. 
It  is  a  powerful  tonic  when  applied  with  water  at  65°  to  75°  F. 
(18.3°-23.9°  C),  and  should  occupy  from  three  to  five  minutes. 
The  tub  is  filled  to  a  depth  of  5  or  6  inches.  The  patient  should 
enter  from  a  warm  bed,  or  his  circulation  should  be  stimulated  by 
exercise.  As  soon  as  he  enters  the  water  he  rubs  his  limbs,  while 
the  attendant  rubs  the  chest  thoroughly  for  a  few  moments  with 
both  hands  and  then  takes  tlie  limbs  in  turn.  The  attendant 
repeats  the  rubbing  of  the  various  parts  quickly  once  or  twice 
more.  The  shallow  water  enables  the  attendant  to  get  at  the 
various  parts  more  readily  than  in  the  full  bath. 

The  half-bath  or  shallow  bath  is  useful  in  cases  of  anemia 
and  in  many  chronic  diseases  of  the  spinal  cord;  in  cardiac 
affections  and  usually  in  cases  of  asthma  oppressed  by  the 
Turkish  or  Russian  bath.  It  is  also  valuable  in  chronic  affec- 
tions of  the  stomach  and  in  constipation.     At  the  higher  tem- 

1  This  bed  lift  may  be  obtained  from  Charles  E.  Dressier,  143  East  23d 
Street,  New  York  City. 


244  HYDROTHERAPY 

peratures  it  is  suitable  for  cases  of  sciatica  and  all  painful  affec- 
tions of  the  lower  extremities  and  pelvis. 


Fig.  56. — Half-bath  with  affusion  (Cohen). 

The  popularity  of  this  bath  has  increased  among  Conti- 
nental physicians  anrl  is  having  a  great  vogue  throughout 
Europe. 

SPRAY  BATH 

Technically,  the  spray  bath,  liesignated  by  French  clini- 
cians bains  a  I'hydrofere,  consists  in  applying  to  the  skin  of  the 
patient  a  continuously  fresh  layer  of  water  in  a  finely  divided 
state.  A  specially  devised  spraying  apparatus  is  used,  which 
affords  a  mechanical  impact  to  the  skin,  exerting  a  marked  sed- 
ative effect  on  the  nerves  and  removing  secretion.  Mineral 
waters  with  gaseous  and  solid  contents  are  used  in  this  way  at 
European  resorts. 

This  bath  is  practically  a  douche  of  very  fine  streams  issuing 


SPRAY  BATH 


245 


from  a  large  perforated  rose  nozzle  attached  to  rubber  tubing. 
It  may  be  applied  horizontally  or  in  any  other  position. 


Fig.  57. — Sprinkler  with  temperature-indicating  handle;  designed  by  Dr.  A. 
F.  Shepherd  of  the  Ohio  State  Hospital  for  the  Insane,  Dayton,  Ohio.  It  is  made 
of  metal,  which  instantly  takes  the  temperature  of  the  water  passing  through  it, 
thus  indicating  to  the  attendant  any  slight  variation  in  the  temperature  of  the 
water.     See  also  the  thermometer  illustrated  on  p.  368. 


Fig.  58. — Spray  bath  and  ice  rub  (Cohen). 

■  The  spray  bath  is  eminently  suitable  for  treating  sunstroke. 
.  The  patient  should  be  stripped  and  put  on  a  cot  covered  with  a 


246  HYDROTHERAPY 

rubber  sheet  and  an  ico-cap  applied  to  his  head.  The  water  is 
supi)licd  from  the  nozzles  in  a  fine  spray  at  the  lowest  tempera- 
ture afforded  by  the  ixiblic  suj)])!}',  or  from  a  supply  cooled  to  a 
temperature  of  55°  or  00°  F.  (12.8°  or  15.0°  C).  \\hen  the  rectal 
temperature  reaches  103°  F.  (39.4°  C.)  he  may  be  wrapped  in 
blankets  and  made  comfoitable  in  bed ;  the  process  being  repeated 
if  the  tem{)erature  rises.  In  subseciuent  baths  it  may  be  pos- 
sible to  reduce  the  temperature  to  101°  F.  (38.3°  C). 

For  the  use  of  the  spray  bath  and  ice  rubbing  in  the  treat- 
ment of  typhoid  fever  see  pi).  71  and  75. 

THE  ABLUTION  OR  WET  MIT  FRICTION 

Teihvaschung  of  the  Germans.  It  is  the  mildest  general 
treatment,  and  can  be  employed  to  advantage  even  in  the  treat- 
met  of  feeble,  bedridden  patients.  The  water  is  b(\st  aiJi)lied 
with  a  wet  bath  mitten.  One  part  of  the  body  after  another 
should  be  rubbed,  first  with  cold  water,  50°  to  75°  F.  (10°-23.8°C.), 
ami  then  with  a  rough  towel.  If  the  circulation  is  j)oor,  alcohol 
may  be  added  to  the  water.  The  skin  of  the  part  treated  should 
become  red  and  warm.  The  intensity  of  the  local  reaction  fur- 
nishes a  guide  to  the  selection  of  the  proper  tonic  measure.  If 
a  good  reaction  is  obtained  with  the  ablution,  stronger  measures 
may  be  used,  of  which  the  douches  have  the  greatest  range  of 
usefulness. 

THE  DRIP  SHEET  OR  SHEET  BATH 

This  important  measure  requires  very  little  apparatus.  The 
best  time  for  its  application  is  late  in  the  afternoon  or  toward 
night.  The  requisites  are  a  pail  or  large  basin  of  water  at  05°  F. 
(18.3°  C);  a  foot-tub  with  water  at  100°  F.  (37.8°  C);  ice-water; 
two  face  towels;  a  bath  towel;  a  bed  with  an  extra  blanket  at 
hand,  and  protection  for  the  floor.  Put  the  sheet  into  the  water, 
letting  the  corners  hang  out.  The  patient,  dressed  only  in  one 
garment,  stands  in  the  foot-tub  containing  the  warm  water. 
One  facetowel  is  then  dipped  in  ice- water,  wrung  out,  and  wrapped 
about  the  head  like  a  turban.     The  nurse  then  places  the  pail 


THE  DRIP   SHEET   OR   SHEET   BATH 


247 


of  cold  water  with  the  sheet  behind  the  patient,  and,  while 
standing  in  front,  seizes  the  wet  sheet  by  two  corners  and  throws 
it  around  the  patient,  without  any  attempt  to  wring  out  the  sheet. 
A  rough,  smart  rapid  rub  apphes  it  everywhere.  This  process 
should  occupy  about  two  minutes.  Then  drop  the  sheet  and 
wrap  in  the  dry  blanket,  and  put  the  patient  to  bed.  Lower 
the  temperature  of  the  water  1  degree  each  day  until  55°  F. 
(12.8°  C.)  be  reached. 


Fig.  59. — Drip  sheet  or  sheet  bath  (Ash ton). 


This  is  the  quickest  and  simplest  method  of  applying  the  drip 
sheet,  and  may  be  modified  or  extended  by  slapping  the  surface 
occasionally  with  the  hand  or  a  wet  towel,  thus  increasing  the 
mechanical  irritation  of  the  skin.  In  addition,  a  basin  of  water 
10°  F.  (5.4°  C.)  colder  than  the  water  used  for  the  sheet  should 
be  provided,  from  which  water  is  poured  over  the  head  and 
shoulders  two  or  three  times  at  short  intervals,  being  alternated 
with  slapping  and  friction  for  from  iive  to  ten  minutes.     In  any 


248  HYDROTHEIIAFY 

given  case  the  physician  may  judge  whether  to  commence  mod- 
erately or  with  the  full  technic.  The  general  effect  is  moderately 
sedative,  with  the  abstraction  of  considerable  heat. 

SPONGING 
Before  sponging  a  patient,  note  first  the  exact  temperature. 
Have  water  ready  at  between  80°  to  90°  F.  (26.7°-32.2°  C.) 
and  also  at  60°  F.  (15.6°  C).  Remove  all  clothing  from  the 
patient  and  have  blankets  over  and  under  him.  Put  the  basins, 
sponges,  and  six  soft  towels,  etc.,  on  a  table  near  by,  so  that  it 
will  not  be  necessary  to  leave  the  patient  for  any  reason  what- 
ever. Commence  the  sponging  at  the  face  and  neck,  applying  a 
cold  compress  at  60°  F.  (15.6°  C.)  to  the  head  and  forehead  after 
sponging.  Si)ongo  downward,  exposing  only  one  limb  at  a  time. 
When  the  whole  body  has  been  sponged,  the  patient  should  be 
flried,  dressed  in  a  night  gown,  wrapped  in  a  warm  blanket,  and 
left  undisturbed  in  bed  for  an  hour  or  longer.  The  temperature 
should  be  taken  at  the  end  of  each  sponging  and  at  the  end  of  the 
hour's  rest. 

Cold  sponging  is  better  borne  by  sensiti\'e  patients  if  there  be 
a  preliminary  sponging  with  tepid  water,  80°  to  90°  F.  (26.7°- 
32.2°  C),  before  applying  the  water  at  60°  to  70°  F.  (15.6°- 
21.1°  C).  A  hot  bottle  at  the  feet  during  'sponging  is  com- 
fortable to  the  patient  and  may  ward  off  a  chill  or  tendency  to 
collapse. 

Patients  who  are  not  particularly  weak  do  not  need  to  be  so 
carefully  dried;  the  arms,  back,  and  chest  may  be  left  to  dry  by 
evajDoration. 

After  the  sponge  the  temperature  usually  falls  from  1°  to  3° 
or  4°  F.  (.54°-16.2°  or  2.2°  C),  the  rapidity  and  extent  of  the  fall 
corresponding  to  the  coldness  of  the  water  employed.  Ammonia, 
alcohol,  cologne,  water,  or  vinegar  added  to  the  water  favors 
cooling  by  rapid  evaporatian. 

In  the  absence  of  a  suitable  sponge,  towels  may  be  wrung  out 
of  cold  water  dry  enough  not  to  drip,  and  placed  about  the 
body,  from  the  neck  downward,     ^^'hen  the  feet  are  reached, 


THE    OIL    RUB  249 

begin  again  at  the  head  and  renew  each  in  succession,  con- 
tinuing as  long  as  necessary. 

Abdominal  Cold  Compress. — To  enhance  the  value  of  the 
sponge  bath,  an  abdominal  cold  compress  is  sometimes  appUed 
after  sponging.  This  is  made  by  dipping  two  towels  into  water 
at  60°  F.  (15.0°  C),  and,  after  partly  wringing  them  out,  they 
are  unfolded  and  placed  across  the  abdomen  and  covered  with  a 
thick  Turkish  towel,  passed  around  the  body. 

RUBS 

THE  OIL  RUB 

In  temperate  climates  it  is  probable  that  the  main  ad- 
vantages from  such  anointing  is  due  to  the  massage;  in  other 
words,  the  circulation  of  the  skin  is  improved,  the  muscles  are 
cleansed  of  excrementitious  products  by  such  debris  being 
forced  into  the  lymph  circulation,  and  the  flow  of  blood  through 
the  muscles  is  improved.  The  oil  rub  has  also  a  good  therapeutic 
use  when  the  skin  of  the  patient  is  always  dry  and  scaly.  Such 
people  probably  do  not  have  a  normal  secretion  from  the  thyroid 
gland,  but  whatever  internal  medication  is  deemed  advisable, 
the  oil  rub  will  add  to  the  improvement  of  the  skin  condition. 

In  tropical  countries  the  oiled  skin  radiates  heat  more 
rapidly  than  the  dry  skin  when  little  or  no  clothing  is  worn, 
On  the  other  hand,  in  cold  countries,  where  much  clothing  is 
needed,  the  oiled  surface  of  the  body  keeps  the  body  warmer. 
It  also  seems  to  be  a  fact  that  after  hot  bathing  a  patient  who 
catches  cold  readily  has  less  hability  to  chilhng  if  an  oil  rub  is 
given. 

Locally,  oil  rubbing  may  be  used,  after  hot  bathing,  for  cold 
feet  or  cold  legs,  and  the  feet  of  such  patients  will  remain  warm 
longer  than  without  it. 

Although  it  hac  been  stated  that  oil  may  be  rubbed  into 
the  body  so  as  to  increase  nutrition,  and  that  weakly  patients, 
especially  infants,  will  improve,  it  is  still  a  question  if  it  is  not 
the  general  toning  up  of  the  circulation,  the  equalization  of  the 


250  HYDROTHERAPY 

circulation,  and  the  prevention  of  flabbiness  of  muscles — in  other 
words,  the  effects  of  the  massage — that  are  the  real  cause  of  the 
improvement  in  the  general  conditon. 

The  body  should  be  first  bathed  with  warm  or  tepid  water, 
dried,  and  the  oil  then  applied;  it  should  not  be  applied  to  the 
dry,  unwashed  skin.  The  oil  should,  of  course,  be  pure  and  clean, 
should  be  well  rubbed  into  the  skin,  and  any  surplus  should  be 
removed  with  a  soft  towel.  Some  knowledge  of  massage  is 
necessary  to  a  successful  oil  rub,  and  tlie  rubbing  should  not  be 
suffici(>ntly  vigorous  to  cause  persj^iration.  The  best  oil  for  this 
purpose  is  pure  olive  oil,  cocoanut  oil,  or  palm  oil;  cottonseed 
oil  ma}^  be  used.     Animal  fats  do  not  make  an  ideal  oil  rub. 

THE  SCOTCH   RUB 

This  is  applicable  to  patients  to  whom  a  cold-water  rub  is 
unpleasant,  and  consists  in  washing  a  ])art  of  the  body  with  hot 
water  and  then  rubbing  with  a  towel  wet  in  cold  water.  "If 
under  such  applications  the  skin  slowly  redden  or  stay  pale 
and  the  skin  muscles  are  contracted,  it  means  an  abnormally 
high  excitability  of  vessel  innervation."  This  condition  is 
found  in  aneniia  and  in  some  feverish  conditions.  "A  livid  red- 
ness of  the  rubbed  area  means  circulatory  insufficiency,"  while  a 
slow  rewarming  or  continued  coolness  of  the  treated  area  in  high 
fevers  "is  suggestive  of  a  pending  circulatory  collapse."  The 
advantages  are  that  the  friction  is  a  mild  stimulant  and  causes 
the  rubb(Yl  area  to  radiate  heat  normally,  while  it  also  increases 
evaporation. 

The  advantage  is  that  this  method  is  pleasanter  to  most 
patients  than  cold  sponging,  and  while  not  tending  to  lower  tem- 
perature immediately  as  effectively  as  does  the  tj'pical  old 
sponging,  it  does  tend  to  keep  the  surface  of  the  body  in  a  health)'' 
condition  and  causes  the  skin  to  give  off  heat  rather  than  to 
retain  it.' 

For  Salt  Rub  or  Salt  Glow,  see  p.  354, 

^See  Dietetic  and  Hygienic  Gazette,  September,  1908;  British  Journal  of 
Nursing,  1908;  Jour.  Amer.  Med.  Assoc,  November  14,  1908. 


NEEDLE   douche;   NEEDLE   SPRAY;    CIRCULAR  DOUCHE     251 

ALCOHOL  RUB 

This  is  an  adjunct  to  hydrotherapy  of  great  value,  usually 
employed  as  a  terminal  measure.  It  improves  the  circulation 
and  adds  tone  to  the  skin,  and  after  packs  or  douches  prepares  the 
skin  for  contact  with  the  outside  air.  Only  grain  alcohol  should 
be  used,  and  it  may  be  used  slightly  diluted  or  pure.  About  2 
ounces  are  sufficient  for  each  rubbing  of  the  entire  body. 

DOUCHES 

Douches  may  be  applied  to  individual  portions  of  the  body, 
depending  upon  the  particular  organs  or  structures  affected. 
The  jet,  the  spray,  the  fan,  or  the  filiform  douche  may  be  chosen 
as  the  parts  require,  and  they  may  be  short,  prolonged,  hot  or 
cold,  or  alternately  hot  and  cold,  and  under  greater  or  less  pres- 
sure— from  10  to  35  pounds  to  the  square  inch. 

Cold  applications,  lasting  one  or  two  minutes,  are  strongly 
stimulant,  producing  a  vigorous  reaction  in  most  cases.  The 
entire  vascular  and  lymphatic  systems  immediately  underlying 
the  exposed  part  are  affected  in  proportion  to  the  pressure 
under  which  the  douche  is  applied.  If  no  pressure  accompany 
the  cold,  the  action  is  superficial,  but  may  in  certain  localities 
produce  reflex  stimulation. 

Hot  applications  allay  pain  or  benumb  the  superficial  cutane- 
ous nerves.  At  a  temperature  of  90°  to  100°  F.  (32.2°-37.8°  C.) 
they  produce  local  and  reflex  sedative  effects. 

NEEDLE  DOUCHE;  NEEDLE  SPRAY;  CIRCULAR  DOUCHE 

In  its  most  effective  form  this  douche  is  delivered  from  a 
series  of  "roses"  having  minute  perforations,  and  arranged  at 
different  heights  on  an  upright  system  of  tubes  connected  with 
the  control  table.  In  modern  appliances  there  are  usually  six- 
teen roses,  the  upper  row  being  adjustable  to  discharge  the 
spray  at  an  inclination  downward,  so  as  to  avoid  the  head  and 
face.  These  roses  can  be  adjusted  to  suit  patients  of  different 
heights.     The  small  volume  of  water  emerging  in  the  needle 


252  HYDROTHERAPY 

douche  allows  a  somewhat  higher  pressure  than  in  douches  of 
larger  volume.  There  is,  however,  a  sharp  stinmlus  to  the 
skin  from  these  innumerable  jets  of  small  caliber,  wliich  gives 
a  sensation  of  needles,  suggesting  the  name.  The  douche 
should  be  started  by  the  operator  before  the  patient  takes  his 
position,  so  as  to  avoitl  any  unexpected  high  temperature. 
Water  contained  in  the  pipes  is  thereby  allowed  to  run  off,  and 
when  the  thermometer  stands  at  the  required  initial  tempera- 
ture the  patient  may  be  called  from  the  adjoining  cabinet  bath, 
in  case  this  be  used  as  the  preliminary  warming  measure.  He 
enters  the  douche  and  turns  around  slowly  to  permit  the  spray 
to  strike  all  parts  of  tlu^  l)ody  below  the  head.  The  illustration 
shows  that  the  two  lower  seric^s  of  roses  expend  their  force 
chiefly  in  zones,  but  this  is  not  'an  objection  to  the  arrange 
ment. 

Hydrotherapeutic  prescriptions  frecjuently  call  for  the  hot- 
air  bath  or  electric-light  bath  as  a  preliminary  measure.  This 
is  usually  to  insure  more  or  less  perspiration  and  capillary  dilata- 
tion. The  electric-Hght  bath  for  five  or  six  minutes,  or  the  hot- 
air  bath  for  eight,  ten,  or  twelve  minutes  or  possibly  longer, 
is  then  followed  innnediately  by  the  circular  douche  of  the 
prescription.  From  one  to  two  minutes  is  usually  sufficient, 
and  during  that  time  the  operator  has  the  opportunity  of  lowering 
the  temperature  of  the  water  as  may  be  prescribed.  As  a  rule, 
there  is  no  need  or  advantage  of  a  change  in  the  initial  pressure. 
The  author  does  not  ai:)prove  of  prescriptions  calling  for  a  rising 
temperature.  The  advantage  is  not  commensurate  wath  the 
danger  of  overstepping  the  mark.  He  rarely  orders  an  initial 
temperature  of  over  105°  F.  (40.6°  C),  believing  this  sufficient 
after  the  use  of  the  cabinet,  in  which  the  temperature  is  usually 
at  150°  to  100°  or  105°  F.  (05.6°-71.1°  or  73.9°  C).  To  raise 
the  temperature  of  the  needle  douche,  and  then  lower  it  to  the 
required  point  in  a  given  time,  is  impossible  for  the  average 
attendant,  and,  even  with  those  of  considerable  experience,  it 
is  a  delicate  matter.  Better  results  will  be  obtained  by  simple 
prescriptions,  e.  g.: 


COLD   DOUCHE 


253 


Hot-air  bath,  eight  to  ten  minutes  or  to  perspiration. 
Circular  douche,  two  minutes,  105°  >  90°  F.  (40.6°  >  32.2°  C),  20  pounds. 
Jet  douche,  one  minute,  90°  >  80°  F.  (32.2°  >  26.7°  C),  15  to  20  pounds. 
Scotch  douche,  one-half  minute,  105°  and  80°  F.  (40.6°  and  26.7°  C),  15  to 
20  pounds. 

Fan  douche,  ten  seconds,  80°  to  78°  F.  (26.7°-25.6°  C),  15  to  20  pounds. 

,       COLD  DOUCHE 

This  is  a  single  stream  of  water  under  pressure  coming  from 
a  nozzle  of  j  or  J  inch  in  diameter  at  a  distance  of  6  to  10  feet 


Fig.  60. — Douche  room.     McLean  Hospital,  Waverly,  Mass.     Marble  wall  of  Ver- 
mont marble. 


from  the  patient.  The  temperature  may  be  regulated  by  valves 
which  govern  the  mixing  chamber  in  the  control  table,  and  may 
be  graduated  from  a  warm  stream  down  to  the  coldest  water 
supplied.  It  is  a  powerful  stimulant  and  useful  for  its  tonic 
effect  after  the  hot-air  bath  and  circular  douche. 

It  is  counterindicated  in  asthma,  as  paroxysms  of  asthmatic 
breathing  may  be  induced.  The  sudden  contraction  of  the 
pulmonary  vessels  restrict  the  area  of  blood  subjected  to  oxida- 


254  HYDROTHERAPY 

tion  in  the  lungs,  the  carbonic  acid  is  not  properly  eliminated, 
and  a  sense  of  suffocation  ensues.  This  is  corrected  as  reaction 
occurs,  and  the  secondary  efi'ects  are  powerful,  tissue  change 
being  highly  stimulated.  Fatigue  gives  place  to  renewed 
energy,  especially  if  the  cold  applications  be  jn-eceded  by  heat 
and  followed  by  vigorous  rubbing. 

As  a  general  thing,  cold  douches  should  follow  hot  applica- 
tions, never  the  revers(>,  although  alternate  heat  and  cold  are 
occasionally  employed;  in  this  case  the  terminal  douche  is  cold. 

Kneipp  Water  Cure. — Cokl  douches  were  the  mainstay  of  the 
famous  Father  Sebastian  Kneipp,  a  Bavarian  priest.  He  and 
his  assistants  applied  this  usually  to  the  lower  limbs,  and  he 
also  ordered  his  j^atients  to  walk  barefoot  in  the  morning  dew 
on  soft  grass  and  adojit  a  spare  diet.  Many  thousands  of 
people  from  all  over  the  world  were  treated  in  this  manner 
twenty  years  ago  with  surprising  results.  Accompanied  by 
suggestion  and  good  circulation  induced  by  this  form  of  treat- 
ment, which  included  early  morning  exercise,  a  great  amount 
of  good  was  undoubtedly  accomplished.' 

Substitute  for  Jet  Douche. — In  the  absence  of  apparatus  for 
the  jet  douche,  a  sul)stitute  may  be  adopted.  The  patient  on 
rising  stands  in  a  bath-tub,  and  turns  the  two  faucets  so  that 
the  water  will  be  delivered  at  about  100°  F.  (37.8  C).  A  large 
bathing  sponge  is  held  under  the  faucet  and  then  pressed  against 
the  back  of  the  neck.  This  is  done  several  times,  and,  the  hot 
water  having  been  turned  off,  the  sponge  is  filled  witli  cold 
water  and  applied  to  the  back  of  the  neck  and  spine  in  the  same 
way.  After  a  brisk  rubbing,  the  patient  partly  dresses  and  lies 
down  for  half  an  hour.  This  may  act  favorably  in  some  cases 
in  which  the  ordinary  plunge  bath  or  shower  is  not  desirable. 

Uses. — Cold  tlouches,  whether  locally  or  generally  applied, 
preceded  by  some  wanning  measure  and  followed  by  friction, 
are  used  for  anemia,  insomnia,  and  headaches.  Acne  of  the 
face  and  thorax  and  a  generally  bad  complexion  are  also  im- 

1  Father  Kneipp  published  a  volume  entitled  Mon  Te.stament,  embodying 
the  principles  of  his  treatment,  Ma  Cure  d'Eau,  1891. 


COLD   DOUCHE 


255 


proved  by  these  measures,  as  are  also  chronic  constipation  with 
muddy  complexion,  general  auto-intoxication,  and  general  mal- 
nutrition. 

Spinal  Douche. — Charcot  used  the  spinal  douche  at  a  low 
temperature,  45°  to  60°  F.    (72°-15.6°  C),  in  cases  of  hys- 


Fig.  61- — Spinal  douche — Charcot  douche  (Gant). 


teria  with  marked  benefit.  It  was  never  applied  except  to  a 
limited  portion  of  the  spine,  and  hence  no  general  depression 
occurred  and  the  reaction  was  easy.  The  limited  spinal  douche 
at  20  or  30  pounds'  pressure  and  at  low  temperature  is  some- 
times referred  to  under  Charcot's  name. 


256 


HYDROTHERAPY 


ALTERNATING   HOT   AND  COLD   DOUCHES 

This  form  of  (louche,  for  some  unknoun  reason  called  the 

Scotch    douche,    i)roduces    distinctly    (>xciting    effects.     It    is 

not  appHcable  to  the  head  or  the  anterior  chest,  but  may  be 

applied  to  the  spine  and  posterior  thorax  and  sides;    to  the 


Fig.  62. — Abdominal  Scotch  or  alternating  liot  and  cold  douche,  the  water  under 
considerable  pressure  (Gant). 


abdomen  and  to  the  lower  extremities.  With  temperatures 
alternating  between  105°  and  70°  F.  (65.6°  and  21.1  C),  or  pos- 
sibly a  few  degrees  higher  and  lower,  good  results  are  obtained; 
in  robust  patients  the  extremes  may  reach  110°  and  55°  F. 
(43.3°  and  12.8°  C.)  or  lower. 

Douches  to  the  Head. — In  applying  a  douche  to  the  head  it 


ALTERNATING   HOT   AND   COLD   DOUCHES 


257 


should  be,  as  a  rule,  cold  or  cool,  without  pressure,  as  given 
from  a  dipper  or  pitcher,  and  the  duration  should  be  onty  a  few 
seconds.  The  immediate  effect  is  a  dilatation  of  the  blood- 
vessels of  the  brain;  if  too  long  continued,  a  secondary  contrac- 
tion and  chilling  occur.     It  may  be  designated  as  an  affusion, 


Fig.  63. — Hepatic  douche  (Gant). 

and  is  used  in  connection  with  the  Brand  bath  or  drip  sheet, 
and'  always  at  a  slightly  lower  temperature,  and  repeated  once 
or  twice. 

It  may  be  applied  in  mental  disease,  as  in  melancholia  and 
hypochondria.  In  cases  of  insomnia,  mania,  and  paresis  the 
water  should  not  be  less  than  80°  F.  (26.7°  C.)  or  more  than  95° 

17 


258 


HYDROTHERAPY 


F.  (35°  C).     Douches  to  the  bare  head  are  generally  inapplic- 
able to  women  on  account  of  the  difficulty  of  drying  the  hair. 


Fig.  64. — Gant's  perineal  (ascending)  douohe. 

For  women  the  full  hath  or  the  spinal  douche  is  to  be  preferred. 
Great  caution  should  be  exercised  in  any  case. 

THE  RAIN  DOUCHE 
This  valuable  form  of  douche  may  be  used  for  general  pur- 
poses of  ablution  and,  for  many  reasons  besides  those  of  economy, 
is  used  as  a  substitute  for  the  general  cleansing  tub-bath.  It  is 
a  common  adjunct  of  public  baths  under  the  name  of  shower- 
bath  (see  p.  .375).  It  is  easily  attached  to  the  household  bath- 
tub for  domestic  purposes  and  is  always  included  in  the  fixtures' 


THE   RAIN   DOUCHE 


259 


used  for  giving  the  circular  or  needle  bath.  In  this  apparatus 
American  manufacturers  set  the  rose  for  the  rain  douche  slightly 
behind  the  head  of  the  standing  bather  and  at  a  moderate  angle, 
so  that,  instead  of  descending  vertically  on  the  head,  the  water 
may  strike  the  back  of  the  neck  and  shoulders  after  the  head 
has  been  sufficiently  wet.  This  allows  the  use  of  soap  and  a 
general  ablution  if  this  be  required. 


Fig.  65. — Rain  douche. 

The  pressure  and  temperature  of  the  descending  or  rain 
douche  may  be  regulated  by  the  bathing  attendant,  who  stands 
at  the  control  table,  but  in  the  public  baths  and  in  private  use 
the  temperature  is  usually  adjusted  by  the  patient  or  attendant 
by  means  of  a  valve  convenient  to  the  bather,  who  is  thus 
enabled  to  employ  colder  water  toward  the  end  of  the  bath. 
The  pressure  does  not  need  to  be  very  great.  Usually  the  city 
pressure  is  sufficient.     The  high  pressures  used  in  the  needle 


260  HYDHOTIIERAPY 

or  circular  douche'  arc  not  rc(iuired  far  the  head,  and  if  over 
30  pounds  to  the  square  inch  may  tlo  harm. 

The  rain  douche  or  shower  is  always  used  after  the  shampoo 
in  the  Turkish  bath  and  before  the  i)lunge.  It  is  highly  desir- 
able before  entering  a  swinuning  i)ool.  in  which  case  it  should  be 
warmer  than  the  pool.     It  is  also  excellent  as  an  after-shower 


Fig.  66. — Mott  combination  "Securo"  shampoo  mixing  valve.     Tilting  basin  with 
brackets  and  stops  (J.  L.  Mott  Iron  W'orks). 

at  a  lower  temperature  than  the  pool  when  that  is  kept  at  from 
70°  to  78°  F.  (21.1°-25.6°  C). 

Many  also  like  the  rain  bath  of  soft  fresh  water  after  sea- 
bathing; but,  as  has  been  noted  further  on,  the  transition  from 
the  cold  water  of  the  ocean  to  the  fresh  water  of  higher  tempera- 
ture is  thermometrically  irrational,  and,  therefore,  the  au.thor 
does  not  approve  of  it.  Much  of  the  benefit  of  sea-bathing 
may  be  lost  in  this  way,  and  the  subsequent  warm  fresh  shower 


FAN   DOUCHE  261 

should  not  be  used  unless  the  bather  is  chilled  with  too  long  an 
exposure  and  fails  to  react.  No  harm,  as  a  rule,  can  result 
from  the  little  sea  salt  that  clings  to  the  skin  after  the  use  of  a 
rough  towel. 

Every  douche  should  be  preceded  by  wetting  the  head  with 
cold  water  and  applying  to  it  a  towel  wet  in  cold  water. 

Effects. — The  rain  douche,  in  brief  appHcations  and  moder- 
ately .low  temperatures,  causes  a  vigorous  nerve  stimulation 
and  strong  reaction.  It  accelerates  metabolism  and  promotes 
the  circulation.  It  is  especially  apphcable  in  nervous  affections, 
functional  disorders,  such  as  neurasthenia  and  hysteria,  neural- 
gias, paresis,  disorders  of  nutrition,  weak  circulation  when  no 
organic  changes  in  the  heart  and  blood-vessels  are  present.  It 
has  a  marked  influence  on  heat  production  and  sweat  formation, 
for  which  applications  of  longer  duration  are  required.  Tepid 
and  warm  rain  baths  have  a  sedative  action  and  are  applicable, 
therefore,  in  very  sensitive  neurasthenic  and  hysteric  subjects. 

By  changing  the  temperature,  now  to  warmer  and  now  to 
colder,  then  quite  warm,  rain  douches  accomplish  much  in  torpid 
conditions  and  enforce  a  good  reaction,  especially  in  anemia  and 
chlorosis,  because  they  bring  about  a  good  nervous  stimulation 
without  heat  abstraction.  They  also  favor  the  action  of  the  skin 
and  reheve  many  of  its  diseases. 

In  hysteric  cases,  and  especially  where  there  is  an  hysteric 
back  to  deal  with,  rain  douches  of  indifferent  temperatures,  fol- 
lowed by  a  Scotch  douche,  105°  and  80°  F.  (40.6°  and  26.7°  C), 
may  be  used.  The  pressure  of  the  Scotch  douche  should  not  be 
more  than  10  or  12  pounds  at  first,  or  with  just  sufficient  force 
for  the  jet  to  reach  the  patient.  On  successive  applications  the 
force  of  the  douche  may  be  increased.  Duration,  fifteen  to  twenty 
seconds. 

FAN  DOUCHE 

This  is  a  modification  of  the  jet  douche.  The  thumb  is 
placed  over  the  nozzle  delivering  the  jet,  breaking  it  into  a 
fan-shaped  stream.  This  douche  is  usually  cool  or  cold  and  is 
a  terminal  measure. 


262 


HYDROTHERAPY 


FILIFORM   DOUCHE 

This  is  an  extremely  small  douche  driven  at  high  pressure, 
as  much  as  GO  pounds  to  the  square  inch  or  even  higher 
(4  to  o  atmospheres).  When  applied  to  tlie  skin  it  acts  as  a 
powerful  countcrirritant  and  stimulant,  and  in  this  respect  its 
mechanical  properties  supersede  its  temperature.  The  filiform 
douche  bears  the  same  relation  to  other  douches  of  larger  volume 
that  electric  currents  of  high  tc^nsion  bear  to  the  ordinary 
galvanic  current.  It  is  useful  in  sciatica  and  other  neuralgias. 
The  dui-ation  is  short,  from  one-half  to  two  minutes. 

The  steam  douche  is  applied  by  means  of  a  similar  apparatus, 
but  carrying  live  steam. 

THE  PERINEAL  OR  ASCENDING  DOUCHE 

All  completely  equipped  douche-rooms  are  provided  with  a 
fixture  in  the  floor  or  between  the  slats  of  the  flooring  for  this 


Pig.  67. — White  celluloid  enameled  perineal  stool  with  opening  in  center  for  use 
in  connection  with  perineal  douche  (J.  L.  Mott  Iron  W^orks).    (See  also  p.  258.) 

douche.     It  is  generally  regulated  from  the  control  table  by  a 
special  valve,  and  the  temperature  and  the  pressure  are  con- 


Aix  douche;  massage  douche  263 

trailed  just  as  in  the  case  of  other  douches.  The  patient  sits 
upon  a  stool  with  a  hollow  or  circular  seat  and  receives  the 
douche  upon  the  jDerineum.  The  usual  form  is  that  of  a  single 
jet,  about  ^  inch  in  diameter,  but  it  maj^  take  the  form  of 
a  spra5^  The  temperatures  employed  are  usually  compara- 
tively low,  60°  to  80°  F.  (15.6°-26.7°  C),  in  order  to  overcome- 
weakness  of  the  bladder,  chronic  ]:)roctitis,  sexual  depression, 
and  psychic  impotence.     It  is  well  suited  for  hemorrhoids. 

The  duration  of  this  douche  may  vary  from  three  to  ten 
minutes,  according  to  individual  requirements.  It  has  some 
advantage  over  the  sitz-bath,  in  that  a  certain  amount  of  me- 
chanical force  is  applied ;  this  force  should  be  sufficient  to  raise 
the  column  of  water  about  30  to  40  inches  from  the  floor. 

AIX  DOUCHE;  MASSAGE  DOUCHE 

This  is  a  combination  of  the  douche  with  vigorous  massage. 
As  practised  for  over  one  hundred  years  at  Aix-les-Bains,  it 
requires  the  services  of  two  attendants,  both  being  provided 
with  a  flexible  tube  or  hose,  bringing  water  at  two  different 
pressures. 

The  two  springs  at  Aix-les-Bains,  the  alum  spring  and  the 
sulphur  spring,  are  about  100  yards  apart,  and  have  almost 
the  same  chemical  composition.  They  are  waters  of  small 
mineralization,  about  35  grains  per  gallon,  alum  not  being  a  con- 
stituent, and  the  amount  of  sulphur  being  very  small;  the  com- 
bined flow  is  about  6,000,000  liters,  or  1,200,000  gallons  in 
twenty-four  hours.  The  temperature  is  113°  F.  (45°  C). 
Water  from  another  spring,  at  52°  F.  (11.1°  C),  serves  to 
graduate  the  temperature  of  the  douche  and  the  baths. 

The  author  visited  Aix-les-Bains  in  1910,  and  was  favor- 
ably impressed  by  the  methods  of  treatment  used  in  that  resort. 

The  Aix  douche  is  described  by  Dr.  Jean  Dardel,^  of  Aix- 
les-Bains,  as  follows: 

"The  douche  of  Aix  is  a  combination  of  the  douche  and 

*  International  Clinics,  vol.  ii,  17th  series,  1907.  See  also  The  Spas  of  Aix- 
les-Bains  and  Marlioz,  by  Francis  Bertier,  J.  and  A.  Churchill,  London,  1877. 


264 


HYDROTHERAPY 


massage,  sometimes  called  doucJic-massage.  This  douche- 
massage  constitutes  the  real  specialty  of  Aix-les-l^ains.  This  is 
not  a  douche,  according  to  the  usual  signification  of  the  word 
douche,  for  the  term  implies  a  colder  and  a  more  rapid  operation. 
Nor  is  it  simply  a  massage.     It   is  a  sjoecial  operation  per- 


formed by  a  petrissarje,  or  kneading  of  the  muscles,  the  patient 
receiving  at  the  same  time  a  general  and  abundant  douche  of  the 
thermal  sulphurous  water. 

"  The  douche  is  given  in  rectangular  chambers,  each  cham- 
ber having  a  dressing-room.  Some  of  these  chambers  are  com- 
pletely closed,  while  others  are  open  toward  the  ceiling.    This 


Aix  douche;  massage  douche 


265 


disposition  allows  the  escape  of  the  vapor,  and  at  the  same  time 
avoids  the  overheating  of  the  atmosphere  in  the  room  where 
the  douche  is  taken. 

"  In  each  cabin  where  the  douche  is  administered,  the  temper- 
ature of  the  water  varies  from  57.2°  to  109.4°  F.  (14°-43°C.), 
and  one  can  have  a  cold,  a  warm,  or  a  tepid  douche,  according 
to  his  need  or  pleasure.  But  the  division  called  the  central 
division  does  not  admit  of  any  but  the  thermal  water  douche. 

"  The  conduits  which  bring  the  waters,  either  mineral  or  cold, 
run  into  vessels  fixed  in  the  wall,  in  wliich  the  waters  are  mixed. 


Fig.  69. — "  Etablissement  Thermal,"  Aix-les-Bains. 

One  of  these  vessels  is  a  reservoir  placed  at  1.65  meters  above 
ground.  The  mixing  of  the  waters  takes  place  in  the  open  air, 
so  that  the  pressure  does  not  vary.  This  mixed  water  is  destined 
to  flow  over  the  back  and  the  upper  parts  of  the  bod3^ 

"  The  second  vessel  for  mixing  the  waters  is  a  closed  box  or 
copper  cistern,  into  which  the  hot  and  cold  waters  flow.  This 
mixed  water  serves  to  flow  over  the  different  limbs  of  the  invalid. 
In  this  second  reservoir  for  mixing  the  waters  the  water  pre- 
serves its  full  pressure,  which  varies  according  to  the  different 
stories  of  the  building  (14,  9,  or  6  meters). 


266 


HYDROTHERAPY 


"  The  invalid  is  seated  upon  a  wooden  chair,  about  1  foot 
high,  furnished  with  one  arm  about  two-thirds  of  a  foot  liigh, 
upon  which  lie  leans;  he  rests  his  feet  upon  a  wooden  stool. 
One  of  the  doucheurs  places  himself  before  the  patient,  iiolding 
under  his  arm  one  of  the  tubes — the  one  which  contains  both  the 
hot  and  the  cold  water.  He  directs  the  water  over  the  different 
parts  of  the  limbs  of  his  patient,  at  the  same  time  frictioning 
and  petrissing  the  muscles;  and,  acconling  to  the  case,  moving 
\hc  joints  about.     The  second  douchcur  keeps  behind  the  invalid, 


111.-  ball,^,   Aix-lc-Hai 


holding  the  tube  which  contains  the  water  from  the  free-air 
vessel.  By  imperceptible  movements  he  waters  the  shoulders 
and  the  back  of  the  invalid,  massaging  at  the  same  time  the 
nuiscles  of  the  neck,  back,  or  trunk.  During  the  whole  time  of 
this  massaging  of  the  different  parts  of  the  body  the  invalid  is 
inundated,  so  to  speak,  with  thermal  waters. 

"  After  a  time,  which  varies  according  to  medical  advice,  the 
patient  leaves  his  chair  and  stretches  at  full  length  on  an  inclined 
table  for  massaging.  The  doucheur.  still  holding  his  tube  of 
mineral  water,  places  himself  bchintl  the  invalid,  and  proceeds 


Aix  douche;  massage  douche 


267 


to  the  massaging  of  the  muscular  masses  of  the  back,  and  of  the 
back  parts  of  the  thighs  and  legs.  Massage  of  the  back  can  also 
be  performed  by  placing  the  invalid  upon  his  chair  in  an  inclined 
position,  his  hands  leaning  on  the  arm  of  the  chair.  Certain 
invaUds,  who  cannot  move  without  great  discomfort,  are  brought 


Fig.  71. — Bathing  pool  (piscine),  Aix-les-Bains. 

to  the  douche  upon  a  camp-bed,  which  they  are  not  obliged  to 
leave  during  the  douche,  and  thus  avoid  every  painful  movement. 
"  The  massage  being  terminated,  the  patient  places  himself  in 
a  corner  of  the  cabin,  and  there  receives  the  douche  in  full,  in 
a  shower,  or  in  a  sprinkle,  which  is  the  most  important  of  all. 
The  last  part  is  extremely  important,  and  the  doctors  know  how  to 
obtain  different  results,  from  the  use  of  a  broken  jet  or  from  a 


268  HYDROTHEIJAPY 

full  jot,  i\\c  jet  falling  on  the  patient  like  a  spout,  throwing  out  in 
full  force  the  water  u[)on  him,  or  coming  gently  upon  him  like  a 
shower  of  rain,  either  in  cold  or  in  warm  showers  or  in  Scotch 
shower-baths  or  douches. 

"  The  douche-massage  being  completed,  the  patient  is  dried, 
wraj)p('(l  up  in  a  flannel  dressing-gown,  and  then  covered  with  a 
woolen  rug,  put  into  a  sedan-chair,  and  carried  to  his  hotel.  He 
is  put  into  bed  thus  wrapped  uj),  and  after  twenty  minutes  or  so 
of  heavy  persjjiration,  he  is  uncovered  and  again  dried,  and  wiped 
by  the  man  whose  duty  it  is  to  helji  him  to  get  out  of  the  maillot, 
or  wraps.     This  done,  the  douche-massage  is  finished. 

"  Occasionally  the  patient  dresses  himself  at  the  end  of  his 
douche  and  goes  out  on  foot,  to  induce  perspiration  either  by 
exercise  or  by  returning  to  his  bed.  But  it  is  prefcu'able  to  return 
in  the  maillot,  well  wrapped  up,  in  the  sedan-chair.  Formerly 
this  method  was  used  exclusively.  Such  is  the  most  usual  form 
of  the  douche  of  Aix-lcs-Bains,  but  its  administration  may  be 
subjected  to  certain  variations. 

"  When  the  douche  is  given  by  a  single  doucheur  the  prepara- 
tion is  the  same  as  when  there  are  two  doucheurs.  The  patient 
is  seated  as  before  on  a  low  chair.  The  doucheur,  holding  the 
tube  which  brings  the  water  from  the  reservoir,  pours  it  over 
the  (lifTerent  limbs  and  the  muscular  parts  of  the  body.  The 
tube,  which  comes  from  a  box  containing  the  mixtures  of  water 
kept  in  the  open  air,  is  fixed  to  a  particular  instrument  which 
ends  with  a  watering  apparatus,  the  water  from  which  flows 
over  the  patient  during  the  whole  operation. 

"  The  local  douche  is  given  in  a  chamber  or  cabin  divided  into 
two  compartments  by  a  wooden  partition,  which  has  two  holes 
bored  through  it  so  as  to  admit  either  the  arm  or  the  leg.  The 
patient  is  seated  on  a  low  chair  and  passes  his  arm  or  his  leg,  as 
the  case  may  be,  through  the  orifice  in  the  partition.  The 
doucheur  is  in  the  other  compartment,  and  he  proceeds  to  mas- 
sage the  arm  or  the  leg,  or  the  affected  part  of  the  arm  or  leg, 
the  thermal  water  flowing  all  the  time,  from  a  flexible  tube  con- 
nected with  the  reservoir,  over  the  member  under  treatment. 


Aix  douche;  massage  douche  269 

"  Corbin  Douche. — In  certain  cases  the  chair  used  for  the  mas- 
sage can  be  replaced  by  a  particular  stool,  and  under  this  stool  is 
fixed  a  crooked  tube  which  is  joined  to  one  of  the  reservoirs  of 
the  mineral  waters  and  which  ends  in  a  watering  spout.  The 
jet  of  thermal  water  strikes  the  region  of  the  perineum,  and  is  of 
great  use  in  the  treatment  of  many  cases  of  hemorrhoids  and  of 
enlarged  prostate.  The  name  of  Corbin  has  been  given  to  this 
particular  douche. 

"  The  vapor  or  steam  baths,  both  local  and  general,  are  given 
in  bouillons,  or  in  the  division  of  the  BerthoUet  apparatus. 

"  The  name  of  bouillons  has  been  given  to  the  cabinets  which 
are  connected  with  a  certain  number  of  douches.  The  mineral 
water  rushes  out  bubbling  from  the  apparatus  which  is  used 
to  produce  this  bubbling  or  boihng,  and  is  converted  into  a 
pulverous,  vaporous  steam  of  104°  to  109.4°  F.  (40°-43°  C.)  of 
heat.  This  vapor  produces  a  rapid  and  abundant  perspiration. 
The  patient  remains  in  this  cabinet  from  three  to  ten  minutes, 
the  vapor  bath  being  at  once  followed  by  a  douche. 

'*  BerthoUet  Apparatus. — The  apparatus  called  BerthoUet  con- 
stitutes another  peculiarity  of  Aix.  The  daily  use  of  this  bath 
requires  a  consumption  of  1,680,000  liters  of  water.  A  special 
arrangement  of  the  BerthoUet  bath  produces  a  mixture  of  air 
and  vapor  from  the  mineral  water  at  a  temperature  of  111.2°  F. 
(44°  C).  This  mixture  is  driven  back  into  a  receptacle  of  cast- 
iron,  situated  in  the  cabinet  where  the  treatment  is  taken.  The 
apparatus,  which  varies  according  to  the  part  of  the  body  to  be 
treated,  is  fixed  to  the  receptacle  containing  the  vaporous  steam, 
and  is  then  directed  to  the  affected  parts,  whether  leg,  arm, 
back,  or  shoulder.  These  different  members  of  the  body  are 
first  wrapped  up  in  an  impermeable  cloth,  so  that  the  currents 
of  damp  hot  air  fall  directly  on  the  parts  to  be  treated.  The 
treatment  lasts  about  twenty  minutes. 

"  The  BerthoUet  bath  can  also  be  taken  in  what  is  called  a 
box-bath.  The  vapor  comes  under  the  box,  so  that  the  whole 
body,  except  the  head,  is  submitted  to  the  action  of  the  heat. 

"  To  the  BerthoUet  is  joined  the  humage.     In  the  cabinet  of 


270  HYDROTHERAPY 

this  name  are  placed  four  tamhours  or  cures,  low  down,  furnished 
with  flexible  tubes.  The  patient  himself  directs  the  current 
of  air  saturated  with  vapor  to  his  throat,  his  nostrils,  his  ears, 
his  face,  or  his  hands. 

''  The  baths  situated  on  the  first  floor  are  fed  with  cold  and 
thermal  water.  Here  the  bathing  is  ])erfectly  good  and  salutary. 
A  certain  number  of  the  batlis  arc^  connected  with  the  douche 
cabinets,  so  that  the  bathing  can  be  effected  before  or  after  the 
douche,  ^\ithout  dressing. 

''  The  baths  called  refrigerating  have  eight  cabinets  in  which 
baths  may  be  taken  in  pure  mineral  water.  The  thermal  water 
flows  here  as  in  all  the  other  baths,  but  it  is  refrigerated  gradually, 
and  the  cool  temperature  is  due  to  a  cool  serpentine  vessel  through 
which  the  water  passes  before  reaching  the  bath.  This  mineral- 
ization is  employed  in  certain  diathesique  manifestations  (morbid 
diathesis)  and  in  dermatoses  (skin  diseases). 

"  A  small  tube  inserted  in  the  tube  of  the  thermal  water  serves 
to  give  the  pressure  113°  F.  (45°  C.)  to  the  bath  called  irriga- 
tion. It  is  a  mediate  douche  resembling  the  sous-niarine  douche 
of  Plombieres.  The  patient,  after  he  has  gotten  into  the  bath, 
directs  the  water-jet  upon  his  body  or  on  the  affected  part,  either 
in  full  jet  or  in  part ;  and,  according  to  the  layer  of  water  between, 
the  jet  is  more  or  less  strong.  The  result  of  this  simple  process  is 
wonderful.  This  last  arrangement  permits  one  to  direct  with 
great  ease  the  mediate-jet  on  to  the  abdomen,  and  unites  the 
effects  of  heat  and  gentle  massage. 

"  The  piscines  are  fed  by  the  same  waters  as  the  baths.  The 
temperature  is  95°  F,  (35°  C).  In  two  piscines  the  temperature 
is  lowered  to  86°  F.  (30°  C.)  from  10  to  11  o'clock  in  the 
morning.  From  a  medical  point  of  view,  the  piscine  is  very  use- 
ful, as  it  permits  the  patients  in  certain  cases  (such  as  trauma- 
tism and  arthritis)  to  move  about  in  the  water,  movements 
which  are  otherwise  difficult  to  make.  The  patient  whose 
articulation  has  been  immobilized  is  able  to  move  about  in  the 
water  because  the  water  bears  him  up.  He  is  thus  able  to  re- 
educate the  movement  of  his  limbs,  and  he  learns  again  to  walk. 


Aix  douche;  massage  douche  271 

"  The  physiologic  action  of  the  thermal  treatment  at  Aix  re- 
sults from,  or  is  caused  by,  many  and  divers  agents.  First,  the 
physical  and  chemical  factors  are :  the  temperature  of  the  water; 
its  unctuousness;  the  abundance  of  the  waters;  a  special  electric 
action;  its  chemical  composition,  viz.,  its  sulphurous  contents. 
Second,  factors  resulting  from  the  manner  of  applying  the 
waters;  massage;  the  mechanical  action  of  the  water;  the  action 
of  the  vapor  or  steam.  Each  of  these  various  elements  has  its 
own  peculiar  action.  The  combination  of  these  various  pro- 
cedures produces  different  results. 

''  The  greater  number  of  those  who  come  to  Aix  have  pre- 
viously undergone  various  treatments,  such  as  douches,  baths, 
massage,  and  vapors.  They  come  to  ask  and  to  look  for  a  new 
treatment  in  the  cure  of  Aix,  which,  happily,  they  find.  This 
action  is  naturally  complex. 

''  The  treatment  of  Aix-les-Bains,  as  has  been  proved  by  ex- 
periment, lowers  the  arterial  tension.  The  action  of  the  treatment 
on  the  nervous  syste?n  is  stimulating  as  well  as  sedative.  The 
effect  produced  depends  on  the  manner  of  applying  the  treat- 
ment; such  as  temperature,  duration,  and  frequency  of  the 
operations.  We  can  obtain  very  different  results  according 
to  the  method  employed.  The  thermal  fever  which  ancient 
authors  were  so  pleased  to  describe  was  only  the  consequence 
of  the  thermal  operations  too  warmly  and  too  frequently  applied. 
That  thermal  fever  was  but  a  result  of  excessive  zeal. 

"  Nourishment  is  influenced  by  the  treatment,  as  urologic  re- 
search has  proved.  The  urine  is  rarefied  and  its  toxic  or  poison- 
ous power  is  increased.  Phosphoric  acid  and  the  mineral  ele- 
ments generally  are  eliminated  in  smaller  quantities;  and  at 
the  same  time  we  see  the  waste  products  of  organic  combustion, 
such  as  urea  and  uric  acid,  increase.  In  a  word,  the  treatment 
has  a  mechanical  action,  both  direct  and  indirect.  The  functions 
of  the  skin  are  stimulated  by  the  flow  to  the  periphery  of  blood, 
which  is  attracted  by  the  warm  water  in  contact  with  it;  an 
abundant  perspiration  is  produced,  and  an  elimination  is  effected 
by  this  means.     On  the  other  hand,  there  is  an  acceleration  of 


'>7) 


HYDUOTHKUAPY 


the  lymphatic  circulation  which  favors  the  resolution  and  re- 
sorption of  the  exudates,  effusions,  and  periarticular  dei)0sits. 
In  a  word,  the  diseased  tissues  tend  to  return  to  their  normal 
eon(  lition. 

*'  Indications. — The  detailed  manner  in  which  we  have  de- 
scribed the  treatment  at  Aix,  and  its  effects,  will  allow  us  to 
make  a  statement,  rather  than  a  long  description,  of  the  patho- 
logic conditions  which  may  suitably  be  treated  by  the  waters  of 
Aix-les-Bains. 

"  The  indication  of  the  treatment  at  Aix  must  be  considered 
every  time  we  wish  to  accelerate  nutrition.  We  must  distinguish 
the  principal  indications  from  the  secondary  ones. 

"The  princii)al  indications  are: 

"  Chronic  rheumatism  in  all  its  forms. 

"  Rheumatism  which  deforms  or  disfigures,  to  which  we  may 
add  the  rheumatic  nodes  of  Ileberdon  and  the  rheumatoid 
arthritis  of  the  English. 

"  Muscular  pains,  lumbago,  torticollis,  and  the  various  pains 
often  called  muscular  rheumatism. 

"  The  scffuehe  of  articular  rheumatism,  both  acute  and  sub- 
acute, in  all  its  forms.  The  seciuelic  of  the  various  conditions 
called  infective  rheumatism, 

"  Gonorrheal  rheumatism. 

"  Asthenic  gout. 

"  Syphihs. 

"  Every  kind  of  neuralgia,  and  particularly  sciatica. 

"  Peripheral  neuritis. 

"  Chronic  arthrites,  joint  stiffness,  hydrarthroses,  posttrau- 
matic, postarthrites. 

"Muscular  atrophy  consecutive  to  an  inflammatory  con- 
dition, a  nervous  affection,  or  trauma. 

"  The  consequences  of  phlebitis. 

"  In  addition  to  those  affections  the  treatment  of  Aix  can 
ameliorate  other  states  of  illness  (secondary  indications)  con- 
nected with  nutrition,  but  the  indication  is  then  less  absolute. 
Massage  in  conjunction  with  the  douche  suits  certain  cases  of 


Aix  douche;  massage  douche  273 

obesity,  diabetic  arthritis,  and  eczemas  connected  with  the 
arthritic  state.  Hydrotherapy  may  be  applied  with  benefit 
in  most  nervous  affections.  Many  uterine  maladies  are  re- 
lieved by  copious  irrigations,  and  the  lavage  is  attended  with 
great  success  in  cases  of  mucomembranous  enteritis. 

"  Coimterindications. — No  invalid  ought  to  undergo  the  ther- 
mal treatment  during  or  while  just  recovering  from  an  acute  at- 
tack of  illness.  This  is  one  of  the  main  counterindications  for  the 
use  of  the  treatment.  Tuberculosis  and  serious  liver  and  kidney 
complaints  are  obstacles  to  the  thermal  treatment.  Compensated 
valvular  lesions  of  the  heart  (rheumatic  endocarditis)  can  derive 
benefit  from  the  treatment  if  well  looked  after.  But  all  the 
other  cardiac  complaints  must  abstain  completely.  As  to  cases 
of  arteriosclerosis,  the  cure  of  Aix  is  not  denied  them;  only 
they  must  be  well  looked  after  by  the  doctore,  who  should  exer- 
cise judgment  and  tact  wliile  having  full  control  over  the  treat- 
ment. 

"  Treatment  of  Syphilis. — The  thermal  treatment  of  Aix-les- 
Bains  is  perfectly  suitable  for  the  cure  of  syphihs.  The  sulphura- 
tion  of  the  water  in  itself  constitutes  a  specific  medication.  It 
is  certain  that  the  douche  combined  with  massage  is  a  valuable 
auxiliary  to  the  iodid  and  mercurial  medication.  The  thermal 
treatment  acts,  in  the  first  place,  by  its  tonic  effect;  second, 
by  aiding  the  absorptive  and  ehminating  functions  of  the  skin; 
third,  by  stimulating  metaboKsm.  It  also  favors  the  passage 
of  medicaments  through  the  organism  by  the  successive  forma- 
tion of  different  albuminomercurials  (by  the  absorption  of  the 
iodomercurial  preparations  and  the  elimination  of  the  waste 
products).  Thus  the  patient,  a  prey  to  an  enfeebling  and  de- 
pressing malady,  sees  an  amelioration  of  his  general  condition. 
He  can  also,  without  fear  of  accident,  absorb  a  larger  dose  of  the 
specific  medicament,  which,  passing  tlirough  the  organism,  acts 
potently. 

"  At  Aix-les-Bains  a  specific  cure  for  patients  can  be  adminis- 
tered at  different  periods  of  the  illness :  old  and  new  lesions,  and 
most  often  tertiary  lesions,  are  continually  treated  here.     Inunc- 

.18 


274 


HVDROTHEUAPY 


tion  of  large  doses  is  often  prescribed;  we  prefer,  however,  in- 
jections of  soluble  mercurial  salts.  For  all  these  patients  the 
douche  of  Aix-les-Bains,  with  the  bouillon,  the  vapor  baths,  and 
the  profuse  sweats  which  icsuit  thcrcfroin,  help  the  action  of 
this  si)ecific  medication,  and  allow  of  the  continuous  administra- 
tion of  a  sufficient  dose.  This  medication,  more  than  any  other, 
requires  an  attentive  medical  attendance. 

**  Zander  Method. — The  department  of  Mechanical  Therapeu- 
tics is  installed  in  a  special  pavilion,  named  the  Vjiinder  Institute. 


l,c:i\iii<;  till-  r)aliis,  Aix-lcs-Haiiis. 


The  Zander  method  consists  in  the  use  of  the  medical  gymnastics 
devised  by  Ling,  for  which  purpose  mechanical  apimratus  is 
employed.  Its  principle  is  to  graduate  and  localize  the  move- 
ments, to  move  each  joint  singly,  to  exercise  each  group  of 
muscles  one  after  the  other,  while  measuring  exactly  the  extent 
of  each  movement,  and  the  energy  of  each  and  every  effort. 

"  In  the  Zander  method  the  resistance  to  be  overcome  by  the 
patient's  effort  (which  resistance  is  represented  by  the  gymnast's 
hand)  consists  in  a  graduated  lever  upon  which  a  weight  can  be 


Aix  douche;  massage  douche 


275 


moved.  Compared  with  ordinary  bodily  exercise,  such  as  sports 
or  gymnastics,  the  mechanotherapeutic  method  offers  many 
advantages,  as  it  divides  the  work  and  diminishes  the  efforts. 
In  the  first, place,  during  the  movement  the  resistance  accom- 
modates itself  to  the  natural  variations  of  the  result  of  muscular 
contraction;  second,  the  energy  of  the  movement  is  measured 
exactly;  third,  the  resistance  to  be  overcome  remains  fixed. 
It  is  possible  to  modify  with  exactness  the  energy  of  the  move- 


.4a  *-tS  i      3^P 


1 


Fig.  73.— The  Aix  douche  (Luke) 

ment,  increasing  or  diminishing  it,  as  the  case  may  be.  Different 
kinds  of  apparatus  have  been  constructed,  some  for  active 
movements,  some  for  passive  movements.  Some  of  the  appli- 
ances are  made  for  mechanical  procedures,  such  as  vibrations, 
percussion,  and  kneading;  others  are  orthopedic  instruments. 
In  the  case  of  all  these  different  appliances  the  doctor  is  sure 
to  exercise  the  right  muscles  and  not  to  touch  the  others;  that 
is,  he  is  sure  not  to  touch  those  unaffected.  He  knows  how  to 
apply  that  amount  of  exercise  which  his  experience  has  shown 


27G 


HYDROTHERAPY 


him  to  be  the  most  useful;  not  to  give  more  than  is  needed,  and 
yet  not  to  fall  short  of  what  is  required.'" ' 

A  modified  Aix  douche  is  sometimes  giv(>n  with  only  one 
attendant  (see  page  275). 

VICHY  DOUCHE 
The  \'ichy  dout-lie  resembles  the  Aix  douche.     The  patient 
lies  in  a  recumbent  iwsition  on  an  india-rubber  air  mattress, 
while  ma.ssage  is  administered  under  a  spray  douche  descending 


Fig.  74. — Pj)t-cial  douche-massage  chair,  allowing  complete  relaxation  (bath)  (Luke). 

vertically  from  three  "  roses  "  about  2  feet  above  the  patient. 
This  douche  is  often  preceded  by  a  steam  or  hot-air  bath  to 
induce  free  perspiration.  After  the  Vichy  douche  is  applied 
for  twenty  minutes  the  circular  douche  or  needle  douche  is  given 
as  a  terminal  measure. 

COMBINED  BATH,   DOUCHE,   AND  MASSAGE 

At  Buxton,  England,  a  combined  bath,  douche,  and  massage 

are  given.     The  illustration  shows  a  patient  recHning  in  a  shallow 

1  A  complete  equipment  of  the  Zander  apparatus  is  installed  at  the  Massa- 
chusetts General  Hospital,  Boston,  and  has  been  purchased  for  use  at  the 
Virginia  Hot  Springs. 


COMBINED    BATH,   DOUCHE,    AND    MASSAGE  277 

tub,  at  a  convenient  height  for  the  attendant,  who  applies  the 
douche  with  massage.  The  partial  immersion  bath  has  a 
temperature  of  94°  to  100°  F.  (34.4°-37.8°  C). 

The  indirect  or  undercurrent  douche  has  a  sli  htly  higher 
temperature  than  the  bath  tself.  Its  temperature  ranges  from 
98°  to  104°  F.  (36.7°-40°  C),  and  the  pressure  about  15  pounds 
to  the  square  inch.  The  caliber  of  this  douche  is  from  ^  to  -^q- 
inch.  It  is  applied  during  the  last  three  to  five  minutes  of  the 
bath  to  tender  joints,  or  any  affected  part  by  holding  the  nozzle 


Fig.  75. — Buxton  massage  and  douche  bath.  This  bath  is  filled  with  water  at 
94°  to  100°  F.  (34.4°-37.8°  C).  The  patient  is  getting  a  partial  immersion  bath 
as  well  as  douche  massage. 

at  a  variable  distance,  allowing  the  intervening  water  of  the  bath 
to  break  the  force  of  the  douche  and  distribute  it  over  a  greater 
or  less  area.  As  the  affected  portion  improves,  the  direct  douche 
may  be  substituted  for  the  undercurrent  method. 

The  douche  massage,  as  applied  at  Aix,  Vichy,  or  Buxton,  is 
very  valuable  in  the  treatment  of  chronic  rheumatism,  gout  with 
arthritis,  also  chronic  muscular  rheumatism. 

In  cases  of  obstinate  atonic  constipation  special  attention 
should  be  given  to  the  liver,  abdominal  muscles,  and  colon. 


278 


hydrothp:rapy 


PERCUSSION  DOUCHE 
In  this  douche,  air  ami  water,  under  liigh  pressure,  are  de- 
livered from  an  apparatus  with  a  special  nozzle.  The  stream 
of  water  is  broken  by  the  contained  air,  and  the  effect  is  to 
intensify  the  mechanical  element  of  the  douche.  It  has  a 
highly  stinmlating  effect,  and  is  useful  in  \isceral  anemias  and 
constipation. 

THE  PAIL  DOUCHE   OR   PAIL-POUR 
This  has  been  referred  to  as  a  final  douche  in  the  half-bath. 
The  water  is  applied  in  considerable  quantity  a  few  feet  above 


Fig.  76. — Rain  and  circular  (needle)  douche  (Gant). 


THE    PAIL   DOUCHE    OR    PAIL-POUR 


279 


the  bather  and  permitted  to  fall  on  the  shoulders  and  back 
(Fig.  77).  It  may  be  at  any  temperature  desired.  It  unites 
with  the  thermic  action  of  the  water  a  mechanical  effec    in  ac- 


Fig.  77. — Pail  douche  (Gant). 


cordance  with  the  height  or  force  with  which  it  is  applied;  it 
is  a  stimulating  measure.  One  or  two  pails  of  water  are  usually 
sufficient. 


280  HYDROTHERAPY 

HOT  LUMBAR  DOUCHE 

A  wonderful  differentiation  of  douches  has  been  attempted, 
designated  as  Plombifere,  Charcot,  Fleury,  spinal,  lumbar,  tho- 
racic, shoulder,  abdominal,  sternal,  epigastric,  hepatic,  renal, 
splenic,  plantar  douches,  and  so  on.  The  hot  lumbar  douche 
may  be  used  in  treating  lumbago.  Claims  are  made  that  the 
douche  over  the  hepatic  region,  at  a  pressure  of  15  to  20  pounds 
and  at  a  temperature  of  G5°  to  75°  F.  (18.3°-23.9  C.)  for  five 
or  ten  minutes,  may  relieve  congestion.  One  of  the  patterns 
of  sitz  bath-tubs  is  provided  with  perforations,  giving  a  needle 
spray  directly  over  the  liver  when  the  patient  is  seated.  In  this 
way  the  temperatures  and  pressures  may  be  nicely  adjusted. 

In  cases  of  chronic  enlargement  of  the  liver  the  temperature 
should  alternate  between  105°  and  70°  F.  (40.6°  and  21.1°  C); 
in  acute  congestion  only  the  higher  temperature  should  be  used. 
In  hepatic  colic  alternating  temperatures  may  be  given;  but  in 
severe  cases  probably  better  results  will  be  obtained  by  the  use 
of  hot  compresses,  frequently  repeated. 

FLEURY  DOUCHE 

In  using  this  douche,  first  a  rapid  general  high-pressure  appli- 
cation of  cold  water,  65°  or  70°  F.  (18.3°  or  21.1°  C),  is  made; 
then  a  strong  jet  at  the  same  temperature  is  directed  over  the 
liver  area  for  from  ten  seconds  to  one  minute.  This  is  followed 
by  a  shower  on  the  epigastrium  and  warm  water  on  the  feet. 
Professors  Raymond  and  Duchennc,  of  Paris,  finding  that  this 
douche  is  not  well  tolerated  and  frequently  harmful,  have 
modified  it,  beginning  with  warm  or  hot  water,  100°  to  113°  F. 
(37.8°-45°C.).     They  advise  the  following  technic: 

Begin  with  100°  to  102°  F.  f37.8°-38.9°  C);  raise  progres- 
sively to  113°  F.  (45°  C),  at  the  same  time  increasing  the 
strength  of  the  jot.  Keep  at  113°  F.  (45°  C.)  until  the  skin 
becomes  dark  red — one-half  to  one  minute — and  then  give  a 
general  cold  or  lukewarm  douche.  This  is  essentially  an  hepatic 
douche.     It  yields  excellent  results  in  hepatic  congestion,  hyper- 


THE    CONTROL   TABLE  281 

trophy,  and  biliary  stasis;  also  in  alcoholism,  dyspepsia,  chronic 
jaundice,  etc.^ 

Chronic  malarial  disease  affecting  the  spleen  and  acute  and 
chronic  nephritis  call  for  similar  treatment.  Renal  calculus  may 
be  treated  by  very  hot  douches  or  compresses  over  the  lumbar 
region.  Every  practitioner  has  seen  good  results  from  these 
measures.  The  author  has  never  used  a  cold  douche  over  the 
kidney,  although  it  is  claimed  that  it  stimulates  the  flow  of  urine 
and  relieves  congestion.  That  the  kidney  can  be  reflexly  stimu- 
lated by  prolonged  cold  applications  to  the  lower  sternum  is 
claimed  by  Beni-Barde  (Kellogg).  The  small  renal  vessels  are 
contracted,  the  pressure  rises  in  the  glomerules,  and  the  urinary 
flow  is  stimulated.  The  author  is  not  aware  that  clinical  evi- 
dence supports  this  view,  although  it  appears  to  be  a  rational 
procedure! 

Good  results  from  these  douches  are  obtained  in  the  treatment 
of  chronic  rheumatism,  gout,  and  in  arthritis  deformans.  Exu- 
dates or  articular  swellings  respond  to  this  form  of  hydrotherapy 
in  connection  with  tub-baths,  warm  packs,  and  massage.  The 
douche  should  be  above  the  body  temperature,  and  may  be 
continued  for  five  to  ten  minutes  at  a  pressure  of  12  to  18 
pounds  to  the  square  inch  As  usually  given  by  the  author  the 
temperature  used  is  104°  F.  40°  C.)  at  the  pressures  stated. 
It  is  an  excellent  preliminary  to  a  tub-bath  of  eight,  ten,  or 
twelve  minutes  at  the  same  temperature  and  undoubtedly 
facilitates  the  action  of  the  hot  dry  pack  This  is  one  of  the 
features  of  the  treatment  of  rheumatism  and  gout  at  the  Virginia 
Hot  Springs,  wher^  the  thermal  waters  have  the  required  tempera- 
ture and  where  a  constant  pressure  is  supplied  by  gravity. 

THE  CONTROL  TABLE 

The  control  table,  which  has  been  perfected  by  various 
makers,  is  a  most  convenient  apparatus  for  administering  all 
forms  of  douches  at  various  pressures  and  at  easily  adjustable 

^  Journal  de  Physiotherapie,  July  15,  1906. 


282  HYDROTHERAPY 

temperatures  (Figs.  78-80).  Tlic  fittings  are  enclosed  in  a 
marble  case.  On  the  side  where  the  operator  stands  are  valves 
for  controlling  the  pressure  and  for  admitting  and  emptying 
the  pipes  which  are  enclosed.  On  top  are  the  valves  which 
control  the  various  outlets,  the  jet  douches,  the  circular 
douche  emerging  from  the  uprights  as  seen  in  the  background, 


FifT.  78. — Hydriatio  control  tabic  with  polished  Italian  marble  f<ides  and  top, 
fitted  with  two  mixing  chambers,  each  with  temperature-regulating  valve,  pressure- 
regulating  valve,  thermometer,  gauge  and  electric  alarm  for  indicating  high 
temperature,  two  special  nozzles,  with  tips  of  three  different  sizes,  quick-opening 
compression  valves  for  the  admission  of  hot,  cold,  and  ice-water  to  the  table,  also 
compression  valves  for  the  control  of  the  water  to  the  various  fixtures  and  douches 
(J.  L.  Mott  Iron  Works). 

the  sitz-bath,  and  the  perineal  douche.  Two  thermometers 
indicate  the  temperatures  of  the  water  delivered  for  use.  Pres- 
sure gauges  show  the  pressure  employed.  An  electric  bell  is 
also  added,  so  as  to  give  warning  when  the  temperature  exceeds 
a  given  limit.  This  operates  by  the  closure  of  a  circuit  when 
the  water  reaches  108°  or  110°  F.  (42.2°  or  43.3°  C). 


THE   CONTROL   TABLE 

i- 


283 


Fig.   79. — Hydriatic  control  table,  showing  arrangement  of  valves  and  tempera- 
ture-regvilutiug  levercs  (J.  L.  Mott  Iron  Works). 


Fig.  80. — Interior  hydriatic  room  at  the  Medical  Bath,  1709  Rittenhouse 
Street,  Philadelphia,  Pa.  Showing  douche  table,  uprights  for  circular  and  rain 
douche,  full  tub,  and  sitz-bath  (J.  L.  Mott  Iron  Works). 

The  douche  table  is  undergoing  a  process  of  evokition,  and 
improvements  are  added  almost  every  year.     These  relate  to  the 


284 


HYDROTHERAPY 


mixing  chambers,  the  levers  or  handles  for  operating  the  various 
douches,  and  the  valves  for  controlling  the  pressures.  It  is  still 
almost  too  expensive  for  private  use,  but  reference  to  the  follow- 
ing list  may  prove  useful  to  the  practitioner  in  referring  patients 
for  treatment.  The  apparatus  is  made  by  J.  B.  Clow  and  Sons, 
Chicago;  The  J.  L.  Mott  Co.,  of  New  York  and  Trenton,  N.  J; 


Fig.  81. — Wall  apparatus;  this  is  a  very  good  sub.^titute  for  the  more  expensive 
control  table  (J.  L.  Mott  Iron  Works). 

The    Hydrotherapeutic  Apparatus  Co.,  of  New  York   (Frank 
Richter),  and  the  L.  Woolf  Manufacturing  Co.,  Chicago. 

The  Hydrotherapeutic   Apparatus  Comjiany  of  New  York 
has  installed  this  table  in  the  following  institutions : 

Connecticut  Hospital  for  Insane Middleto^\n,   Conn. 

U.  S.  Government  Hospital  for  In.cane,  St.  Elizabeth A\'ashington,  D.  C. 

Louisville  Sanitarium Louisville,  Ky. 

Manhattan  State  Hospital Central  Islip,  L.  I. 

Danvers  Lunatic  Hospital N.  Danvers,  Mass. 

McLean  Hospital.  Massachusetts  General  Hospital Waverly,  Mass.    - 

Dr.  Channinff's  Sanitarium Brookline,  Mass. 

Hydriatic  In.stitute,  .J.  M.  Colby Boston,  Ma.ss. 

New  England  Hospital  for  Women  and  Children Boston,  Mass. 

House  of  the  Good  Samaritan Brookline.  Mass. 


THE   CONTROL  TABLE  285 

Medical  Baths,  Farragut  Building Boston,  Mass. 

Bridgewater  Normal  School Bridgewater,  Mass. 

Greylock  Rest North  Adams,  Mass. 

Lakewood  Hotel Lakewood,  N.J. 

The  Agnew  Hotel  (2) Atlantic  City,  N.  J. 

Hydriatic  Institute,  635  Park  Ave New  York  City. 

Riverside  Baths,  Rain  Baths,  and  Hydriatic  Department  .New  York  City. 

Dr.  Parson's  Private  Home  for  Nervous  Invalids Greenmont,  N.  Y. 

Dr.  Bond's  House  for  Nervous  Cases  and  Habit  Cases Yonkers,  N.  Y. 

The  Loomis  Sanitarium  for  Consumptives Liberty,  N.  Y. 

St.  Lawrence  State  Hospital Ogdensburg,  N.  Y. 

Manhattan  State  Hospital,  West Ward's  Island,  N.  Y. 

Manhattan  State  Hospital,  East Ward's  Island,  N.  Y. 

St.  Vincent's  Retreat Harrison,  N.  Y. 

Binghamton  State  Hospital Binghamton,  N.  Y. 

Rochester  State  Hospital Rochester,  N.  Y. 

Hudson  River  State  Hospital Poughkeepsie,  N.  Y. 

German  Hospital,  Girard  Ave Philadelphia,  Pa. 

Orthopedic  Hospital  and  Infirmarj^  for  Ners'ous  Diseases.  .Philadelphia,  Pa. 

Philadelphia  General  Plospital  (Blockley) Philadelphia,  Pa. 

Jefferson  Hospital Philadelphia,  Pa. 

Pennsylvania  Orthopedic  Institute,  1711  Green  St Philadelphia,  Pa. 

Butler  Hospital  (2) Providence,  R.  I. 

The  Homestead  (2) Hot  Springs,  Va. 

New  Milwaukee  Sanitarium Wauwatosa,  Wis. 

Sheppard  and  Pratt  Hospital Towson,  Md. 

Vanderbilt  Clinic New  York  City. 

The   Plaza New  York  City. 

The  Poinciana Palm  Beach,  Fla. 

The  following  are  some  institutions  in  which  J.  B.  Clow's 
hydrotherapeutic  apparatus  is' installed: 

MassiUon  State  Hospital MassiUon,  Ohio. 

Dayton  State  Hospital Dayton,  Ohio. 

Cleveland  State  Hospital Cleveland  Ohio. 

Columbus  State  Hospital Columbus'  Ohio. 

Hotel  Chamberlin Fort  Monroe,  Va. 

Buffalo  State  Hospital Buffalo  N.  Y. 

State  Hospital  for  Insane Warren  Pa. 

Philadelphia  General  Hospital Philadelphia,  Pa. 

South  Dakota  Hospital  for  the  Insane Yankton,  So.  Dak. 

Danvers  State  Hospital Hawthorne,  Mass. 

Livermore  Sanitarium Livermore   Cal. 

Mendocino  State  Hospital Ukiah,  Cal. 

Government  Hospital  for  the  Insane Washington,  D.  C. 

Psychopathic  Ward.  University  Hospital Ann  Arbor,  Mich. 


286 


HYDROTHERAPY 


Departmrnt  for  Insane,  Cook  County  Institutions Dunninp,  III. 

Eastern  Illinois  Hospital  for  Insane Kankakee,  111. 

San  Ambrosia  Hospital Cuba. 

Mercedes  Hospital Cuba. 

Centro  Asturiano Cuba. 


f-pC' 


iK 


German  model  of  control  or  douche  table. 


Partial  list  of  institutions  where  the  J.  L.  Mott  Co.'s  hj-dro- 
therapeutic  cquipnients  are  installed: 

Buffalo  State  Hospital Buffalo,  N.  Y. 

Glockner  Sanitarium Colorado  Springs,  Colo. 

Mendocino  State  Hosjiittil Ukiah,  Cal. 

Napa  State  Hospital  for  Insane Napa,  Cal. 

Pennsylvania  State  Lunatic  Hospital Harrisburg,  Pa. 

Southern  Pacific  Co's.  Hospital San  Francisco,  Cal. 

State  Hospital  for  Insane Cherokee,  Iowa. 

State  Hospital  for  Insane Indejjendence,  Iowa. 

State  Hospital  for  Insane Mt.  Pleasant,  Iowa. 

Medical  Baths 1707  Rittenhouse  Street, 

Philadelphia,  Pa. 

St.  Francis  Hotel San  Francisco,  Cal. 

Charlotte  Sanitarium Charlotte,  N.  C. 

^  St.  Mary's  Ho.spital Pueblo,  Col. 

Michael  Reese  Hospital Chicago,  111. 

New  Na^■y  Hospital Washington,  D.  C. 

Piedmont  Sanitarium Atlanta,  Ga. 

Rochester  State  Hospital Rochester,  Minn. 

South  Side  Hospital Pittsburg,  Pa. 


THE    WARM    FULL   BATH  287 

State  Insane  Asylum Jackson,  La. 

State  Hospital Patten,  Cal. 

Dr.  Adler's  Sanatorium San  Francisco,  Cal. 

Cayuga  Lake  House Sheldrake  Springs,  N.  Yc 

Medical  Bath  Establishment New  York  City. 

Oliver  Building Pittsburg,  Pa. 

Rockefeller  Institute  for  Medical  Research New  York  City. 

St.  Francis  Sanitarium DenviUe,  N.  J. 

The  Royal  Victoria  Hospital Montreal,  Canada. 

Lancaster  General  Hospital Lancaster,  Pa. 

State  Hospital  for  Insane Warren,  Pa. 

London  Insane  Asylum i Ontario,  Canada, 

AFFUSIONS 

These  are  used  in  connection  with  the  half-bath,  the  Brand 
bath,  or  as  an  independent  measure.  They  are  decidedly  stimu- 
lating and  hence  are  valuable  to  rouse  the  unconscious  patient. 
In  cases  of  sunstroke  they  are  remarkably  successful.  The 
patient,  stripped  or  covered  with  a  sheet,  is  placed  on  a  cot 
protected  by  rubber.  Basins  of  very  cold  water  are  then 
forcibly  dashed  on  the  patient  from  a  distance  of  several  feet. 
In  severe  cases  a  small  stream  may  be  allowed  for  a  few  moments 
to  fall  on  his  forehead.  This  is  to  be  repeated  every  two  or 
three  minutes  until  his  temperature  falls  to  103°  or  104°  F.  (39.4° 
or  40°  C),  when  the  patient  is  wrapped  in  blankets  and  sur- 
rounded with  hot  bottles.  This  latter  is  a  complementary 
feature  of  the  affusion,  for  sweating  will  probably  ensue  after  a 
short  interval  in  the  warm  pack;  it  is  the  restoration  of  this 
function  which  saves  the  patient. 

CONTINUOUS  BATHS 

THE  WARM  FULL  BATH 

A  large  tub  is  filled  three-quarters  full  of  water  at  95°  to  100° 
F.  (35°-37.8°  C),  in  which  the  patient  is  fully  immersed,  first 
having  his  head  covered  with  a  cloth  wet  in  cold  water.  The 
room  should  be  at  a  temperature  of  about  80°  F.  (26.7°  C.)  and 
means  should  be  at  hand  for  maintaining  the  water  at  its  initial 
degree  of  heat,  for  this  bath  is  usually  prolonged  to  ten,  fifteen, 


288 


HYDROTHERAPY 


or  twenty  minutes  or  more,  as  required.  Indeed,  the  duration 
of  the  bath  has  been  extended  by  Hebra,  Zuschlag,  and  others 
to  days  and  even  months,  the  patients,  some  of  whom  suffered 
from  extensive  burns,  bed-sores,  pemphigus  and  other  skhi 
diseases,  existing  in  the  continuous  bath  for  remarkably  long 
periods.^     If  continued  for  several  hours,  the  patient  may  sleep 


Fig.  83. — Porcelain-enameled  iron  roll-rim  continuous  bath  with  automatic  regu. 
lator  (J.  L.  Mott  Iron  Works). 


in  the  bath,  but  he  naturally  requires  constant  attendance, 
special  lifting  apparatus,  and  electric  and  other  appliances 
for  ma  ntaining  a  constant  temperature  For  surgical  and 
dermatologic  purposes  100°  F.   (37  8°  C.)  is  considered  best. 

^  One  of  Hebra's  patients  lived  in  a  bath  for  over  one  year  and  is  said  to 
have  gained  14  pounds.     See  also  p.  169. 


THE   WARM   FULL   BATH 


289 


Mutton  suet,  lanolin,  or  petrolatum  applied  thoroughly  to  the 
skin  protects  it  from  puckering  and  peeling. 

Research  by  Dr.  Achilles  Rose  in  the  history  of  the  continuous 
bath  as  a  therapeutic  measure  shows  that  its  introduction  has 
been  ascribed  to  two  German  surgeons,  Fritz  and  von  Walther, 
who  lived  during  the  latter  part  of  the  eighteenth  and  the  first 
quarter  of  the  nineteenth  centuries ;  others  ascribe  it  to  Baude- 
locque,  the  great  obstetrician  of  the  time  of  Napoleon  I.  Baude- 
locque  made  use  of  it  in  peritonitis.     His  method  was  revived 


Fig.  84. — Porcelain-enameled  iron  roll-rim  continuous  baths  (J.  L.  Mott  Iron  Works). 


by  Noeggerath  in  the  German  Hospital  of  New  York,  but 
abandoned  again  after  Noeggerath's  departure. 

The  first  who  used  the  continuous  bath  in  surgery  seems  to 
have  been  Paulus  of  ^Egina,  who  lived  in  the  seventh  century 
under  the  reign  of  Heraclius,  the  Byzantine  emperor.  Paulus 
had  patients,  operated  on  for  hernia,  especially  children,  sub- 
merged in  warm  water  for  seven  consecutive  days  in  order  to 
prevent  inflammatory  symptoms. 

All  these  early  advocates  of  the  continuous  bath,  beginning 

19 


290 


HYDUOTHERAPY 


with  Paulus  of  ^Egina,  antl  later  on  Stromeyer  and  Langenbock, 
in  the  explanation  of  the  effects  of  the  continuous  bath  pro- 
nounced— although  they  did  not  say  the  name — antiseptic 
principles.  All  who  have  had  experience  with  it  will  confess 
that  it  is  still  the  most  reliable  antiseptic  in  extensive  burns. 

Dr.  Riess,  of  Berlin,  thirty-five  years  ago,  and,  later.  Dr. 
James  Barr,  of  Liverpool,  used  the  continuous  bath  extensively 
in  typhoid  fever  and  various  internal  diseases,  but  for  a  long 


Fig.  85. — Interior  of  room  for  continuous  baths  (J.  I..  Mott  Iron  Works). 

time  it  never,  excepting  in  mental  cases,  obtained  very  wide 
recognition  outside  of  the  dermatologic  clinics  of  Hamburg, 
Berlin,  and  Vienna  (see  p.  208). 

Indications. — In  formidable  diseases,  like  pemphigus,  Kaposi 
shows  that  it  relieves  the  pain,  reduces  fever,  and  enables  the 
patient  to  pass  safely  through  the  period  of  eruption  during 
which  he  otherwise  might  have  succumbed.^ 

^  Baruoh,  Hydrotherapy,  2d  cd.,  p.  223. 


HOT-WATER   BATHING  291 

Prolonged  warm  baths  are  suitable  for  cases  with  bed-sores, 
compression  myehtis,  locomotor  ataxia,  and  paraplegia  with 
paralysis  of  the  bladder  and  bowels,  inoperable  cancer  of  the 
urogenital  tract,  obstinate  cases  of  sciatica,  and  muscular  and 
articular  rheumatism.  They  have  been  advocated  for  chronic 
meningitis,  hemiplegic  contractures,  and  general  hyperesthesia. 

Warm  baths  of  short  duration  are  valuable  in  all  febrile 
affections  in  infants  and  young  children,  in  cerebrospinal  menin- 
gitis,^ in  acute  mania,  and  other  excited  nervous  conditions. 
They  exert  a  decidedly  corrective,  calming  effect,  the  pulse 
becoming  softer  and  less  frequent,  and  the  respiration  falling  in 
rate.  The  peripheral  arteries  are  dilated  and  peripheral  sen- 
sibility is  blunted.  Friction  and  other  movements  are  not  gen- 
erally required  in  the  warm  bath. 

In  violent  cases  the  hammock  has  been  used  to  envelop  the 
body  while  subjected  to  the  continuous  bath.  This  has  been 
used  successfully  at  the  J.  Hood  Wright  Memorial  Hospital, 
New  York,  and  in  the  Manhattan  State  Hospital.  Cases  of 
chronic  meningitis  with  violent  delirium  may  be  safely  treated 
in  this  way  and  better  than  in  a  straight-jacket.  The  late  Dr. 
E.  C.  Dent,  of  New  York,  was  the  first  in  the  United  States  to 
use  this  bath  in  insanity. 

Cases  of  atheroma,  angina  pectoris,  and  other  cardiac  cases 
are  not  proper  subjects  for  the  warm  bath. 

Warm  baths  of  half  an  hour's  duration  are  very  useful  in 
amenorrhea  and  dysmenorrhea.  In  the  latter  case  the  tempera- 
ture may  be  raised  to  110°  F.  (43.3°  C).     (See  p.  221.) 

HOT-WATER  BATHING 

Hot-water  baths,  between  104°  and  115°  F.  (40°  and  46.1*^ 
C),  vary  in  their  effect  according  to  their  temperature  and  dura- 
tion. It  usually  requires  a  gentle  graduation  in  successive 
baths  to  withstand  baths  of  105°  F.  (40.6°  C.)  or  over,  and 
people  vary  greatly  in  their  sensitiveness  to  hot  water.     Different 

1  See  page  87. 


292 


HYDROTHERAPY 


parts  of  the  body  vary  in  this  respect;  the  feet,  for  instance, 
being  mucli  more  sensitive  than  the  hands. 

The  Japanese  practice  hot-water  bathing  more  than  any 
other  people.  It  is  said  that  they  commonly  take  five  baths  a 
day  and  usually  have  the  water  at  from  113°  to  128°  F.  (45°- 
53.3°  C.).^  The  head  is  bathed  in  hot  water  before  entering 
the  bath,  which  is  prepared  in  wooden  tubs,  a  common  sight 


Fig.  86. — Kusatsu  Hot  Springs,  No.  1,  inside  the  bath-house  for  men.  Tlic 
water  is  from  130°  to  160°  F.  (54.4°-71.1°  C),  and  would  scald  anyone.  By 
spla.shing  these  boards,  the  water  in  an  hour  is  reduced  to  120°  F.  (46.8°  C),  when 
patients  can  safely  enter,  though  even  then  they  .shrink  from  the  almost  intolerable 
heat.  The  water  might  be  cooled  by  pouring  in  cold  water,  but  this  would  spoil 
the  medicinal  qualities. 


in  Japan,  where,  in  Tokio  alone,  upward  of  400,000  hot  baths 
are  given  daily.  The  temperature  of  the  body  rises  to  about 
104°  F.  (40°  C.)  in  the  course  of  six  to  eight  minutes,  but 
returns  to  normal  in  about  half  an  hour.  Cold  affusions  are 
applied  after  the  bath.  This  custom  is  common  to  all  classes 
of  Japanese.  A  porter  with  his  load  may  become  fatigued  to 
the  point  of  exhaustion;   he  drops  it  for  ten  minutes  while  he 

1  L.  Hill,  Brit.  Med.  Jour.,  February  2,  1907. 


HOT-WATER   BATHING 


Fig.  87. — Kusatsu,  No.  2.  The  patients  have  to  pour  hot  water  over  their 
heads  one  hundred  times  before  entering,  in  order  to  prevent  bad  effects.  In  this 
illustration  they  are  dressed  for  the  sake  of  the  picture.  Generally  there  is  no  such 
display  of  proprietj%  but  just  the  reverse. 


Fig.  88. — Kusatsu,  Xo.  3.  They  all  get  in  together  at  the  command  of  the 
bath-master,  and  endure,  as  best  they  can,  the  semiscalding  for  three  or  four 
minutes,  and  when  the  time  is  announced  for  exit,  they  get  out  much  faster  than 
they  got  in. 

takes  a  hot  bath  at  some  public  bath-house,  emerges  refreshed 
and  strengthened,  and  goes  on  his  way  rejoicing. 


294 


HYDROTHERAPY 


Warm  baths  have  more  advocates  of  late  than  formerly. 
The  time-honored  English  practice  of  the  morning  cold-water 
bath  and  the  popularity  of  sea-water  bathing  during  the  summer 
at  all  coast  resorts  possibly  accounts  for  the  neglect  of  the  warm 
bath.  Of  course,  the  absence  of  bath-tubs  and  of  hot  water 
in  summer,  especially  when  gas  ranges  are  used  for  cooking,  are 
factors.  In  India  the  English  discovered  long  ago  that  they 
must  modify  their  bathing  habits.     Those  who  gave  up  their 


Fig.  89. — Kusatsu  Hot  .Sjirings,  botwopn  the  volcariops  As:ima  and  Shirane. 
The  peak  of  Shirane  appears  in  the  distance,  wiu-re  a  crater  lake  is  being  made. 
The  exterior  of  tiie  bath-house  whose  interior  is  shown  in  Figs.  86-88.  Hundreds 
of  people  afflicted  with  .syphilis  and  lepros3'  gather  at  this  famous  hot  spring. 

accustomed  morning  cold  plunge  and  substituted  a  warm  bath 
found  themselves  in  better  condition  to  stand  he  climate  than 
those  who  adhered  to  the  use  of  the  cold  bath.  There  was  less 
nerve  exhaustion  because  there  was  less  demand  on  the  heat- 
producing  functions.  On  the  other  hand,  the  cold  bath  stimu- 
lates the  heat  centers  to  great  activity.  If  it  were  not  so,  none 
of  us  could  withstand  the  chill  of  the  ocean.  Surf- bathing  would 
be  impossible;  the  blood  would  not  seek  the  periphery  after 
the  first  shock. 


THE   TURKISH   BATH    (DIAPHORETIC) 


295 


THE  TURKISH  BATH    (DIAPHORETIC) 

Well-equipped  establishments  are  found  in  every  large  city. 
The  objects  to  be  attained  by  the  Turkish  bath  are  various. 
As  a  hygienic  measure  the  public  employs  it  extensively  without 
medical  advice  and  usually  with  decided  benefit.  Its  effects 
are  cleansing,  refreshing,  and  stimulating  to  the  circulation. 
It  hastens  recovery  from  the  effects  of  alcoholic  excesses  better 
than  any  other  procedure.  It  favors  elimination  through  the 
lungs  and  the  skin,  and  tends  slightly  to  reduce  excessive  weight. 


Fig.  90. — The  calidarium.     Turkish  bath  (Luke). 


After  disrobing,  the  patient  places  a  loin  cloth  about  the 
body,  takes  a  drink  of  water,  either  hot  or  cold,  and  enters  a 
room  with  dry  air  at  a  temperature  of  110°  to  130°  F.  (43.3°- 
54.4°  C).  In  ten  or  fifteen  minutes  perspiration  appears. 
Superficial  massage  is  then  employed  to  induce  a  greater  degree 
of  perspiration,  and  sometimes  a  hot  foot-bath,  hot  spray,  or  hot 
full  bath  is  given.  After  perspiration  is  established  the  patient 
enters  a  room  at  150°  to  200°  F.  (65.6°-93.3°  C.)  for  a  few 


296 


HYDROTHERAPY 


minute!?  or  until  perspiration  is  very  free.  The  next  procedure 
is  a  vigorous  rubbing  with  bare  hands,  followed  by  a  soap  sham- 
poo, the  subject  lying  on  a  marble  slab.  *  In  the  shampooing 
process  the  bathers  use  the  loofah,  or  Egyptian  fibrous  sponge. 
Next  the  patient  takes  a  cold  douche  at  60°  F.  (15.6°  C.)  or, 
if  perspiration  be  still  rather  free,  he  should  have  a  rain  douche, 
the  temperature  being  reduced  in  from  one  to  three  minutes 
from  85°  to  75°  or  60°  F.  (29.4°-23.9°  or  15.6°  C).  The  next 
step  is  the  swimming  hatli  with  water  at  about  60°  F.  (15.6°  C), 


I  ip.  01. — The  cooling  room.     Turkish  bath  (Luke). 

or  the  patient  may  lie  down  until  the  skin  is  dry  and  the  pulse 
is  normal.  A  cup  of  coffee  or  a  cigarette  or  two  may  be  allowed 
in  suitable  cases.  Lighting  a  cigarette  during  an  alcohol  rub 
caused  a  serious  accident  recently  in  a  Turkish  bath  establish- 
ment in  Philadelphia.  The  alcohol  w^hen  applied  to  the  body 
took  fire,  with  the  result  that  the  bather  had  to  be  sent  to  the 
hospital. 

The  great  stimulus  to  the  sweat  glands  is  the  marked  feature 
of  the  bath,  and  the  secretion  is  increased  tenfold  during  the 


THE    TURKISH    BATH    (DIAPHORETIC)  ^  297 

hour's  treatment.  By  as  much  as  the  blood  is  drawn  to  the 
surface  of  the  body,  by  so  much  are  the  liver,  spleen,  stomach, 
and  intestines  relieved  of  any  tendency  to  stasis. 

The  inhalation  of  hot  air  stimulates  the  secretions  of  the 
pulmonary  mucous  membrane,  and  through  the  lungs  and  the 
skin  several  pounds  of  fluid  may  be  lost.  If  drink  is  restricted, 
the  loss  is  naturally  greater  than  when  fluids  are  taken.     Hence 


Fig.  92. — rThe  shampoo,  showing  use  of  Clow   shampoo  spray  and  temperature. 

indicating  handle. 

it  is  that  Turkish  baths  are  sometimes  used  for  the  reduction  of 
weight.  They  are  not  very  effective  unless  prolonged  for  an 
hour,  and  many  people  who  are  corpulent  are  not  strong  enough 
to  take  such  baths  at  frequent  intervals. 

If  Turkish  baths  are  taken  regularly,  one  should  purchase 
a  loofah  with  a  linen  tag,  so  that  it  may  be  reserved  for  his 
exclusive  use. 


298 


HYDROTHERAPY 


Indications  for  the  Turkish  Bath. — This  bath  is  an  excellent 
clcaujjiiig  process  and,  taken  at  moderate  intervals,  is  a  good 
sanitary  measure.  In  all  large  cities  and  in  many  clubs  and 
sanatoria  Turkish  baths  are  found.  It  is  generally  remarkeil 
that  the  attendants  maintain  a  good  standard  of  health  and  do 
not  seem  to  be  exhausted  or  reduced  by  their  la])ors  in  the  huniitl 
air  of  the  baths.     Their  skin  is  usually  the  pink  of  j)erfection. 


\ 


M 


-    \1 


© 


Fip;.  03. — Clow's  Italian  marble  shampoo  table. 


In  any  case  of  acute  pharyngitis  in  which  the  surface  feels 
raw  or  scraped,  the  Turkish  bath  gives  relief,  as  it  does  also  in 
cases  of  suppression  of  menstruation  from  cold.  In  the  treat- 
ment  of  obesity,  alcoholic  habit,  diabet'.^s,  chronic  dyspepsia, 
and  the  gout  of  corpulent  persons  it  is  also  beneficial.  Among 
syphilitics,  neurasthenics,  and  insane  patients  there  are  many 
who  would  be  much  better  for  Turkish  baths:  and  selected 
cases  of  neuritis  and  chronic  myelitis  show  much  improvement 
when  treated  in  this  manner.  For  anemia  and  chlorosis  they 
are  admirable.     In  ordering  Turkish  baths  for  gouty  patients  it 


THE   TURKISH   BATH    (DIAPHORETIC)  299 

should  be  remembered  that  heat  will  generally  bring  on  acute 
symptoms  in  the  affected  joints.^ 

Counterindications  for  the  Turkish  Bath. — In  all  cases  of 
cardiac  dilatation,  cardiac  asthma,  tachycardia,  arteriosclerosis, 
cases  with  high  blood-pressure,  congestion  of  the  lungs,  chronic 
bronchitis  with  emphysema,  and  exophthalmic  goiter,  this  bath 
should  be  avoided. 

Whenever  in  cases  of  organic  heart  disease  there  is  deficient 
or  failing  compensation,  these  baths  may  do  harm.  While 
some  cases  of  nephritis  are  benefited,  care  must  be  exercised 
and  the  patient  be  under  competent  observation  during  their 
use.  In  advanced  Bright's  disease  the  Turkish  bath  is  positively 
counterindicated.^ 

The  Turkish  bath  is  Ukewise  counterindicated  in  skin  diseases 
accompanied  by  eruptions  on  account  of  the  excessive  congestion 
of  the  skin  induced;  vapor  or  Russian  baths  are  preferable. 
They  are  also  to  be  avoided  in  cases  with  a  history  of  apoplexy 
and  in  most  pulmonary  diseases. 

Objections  to  Turkish  Bath. — ^There  are  a  great  many  objec- 
tions to  the  Turkish  bath.  In  the  first  place,  the  air  in  these 
establishments  is  necessarily  hot  and  usually  vitiated.  The 
hot  rooms  retain  much  of  the  effete  matter  excreted  by  the 
different  bathers  and  attendants.  In  this  respect  they  are 
decidedly  more  objectionable  than  places  where  the  heating 
process  is  accomphshed  by  means  of  hot-air  cabinets  or  electric- 
light  cabinets.  The  latter  are  far  preferable  and  secure  a  better 
ehminant  effect  without  compelling  the  bather  to  breathe  bad 
air.  The  system  of  tonic  hydrotherapy  described  on  pages  252 
and  253  undoubtedly  favors  greater  oxidation  by  enhancing  the 
oxygen-carrying  power  of  the  blood;  it  leaves  the  body  in  a 
fresher  and  more  resistant  state,  thus  enabling  the  bather  to 
return  more  promptly  to  his  home  with  less  danger  of  taking 
€old.  Of  course,  in  the  Turkish  bath  the  final  cold  plunge 
provides  in  great  measure  against  this  latter  danger. 

1  See  p.  122. 

2  See  Wintemitz,  System  of  Physiologic  Therapeutics,  vol.  ix,  pp.  262-267. 


300  HYDROTHERAPY 

Dr.  Hobart  A.  Hare  gives  some  good  advice  as  to  the  Turkish 
bath  as  follows : 

"At  the  present  time  there  can  be  no  doubt  that  a  consider- 
able number  of  persons  are  actually  damaged  by  the  employment 
of  heat  in  the  treatment  of  many  conditions  from  which  they 
think  they  are  suffering.  In  the  great  majority  of  these  cases 
the  patient  takes  it  upon  himself  to  prescribe  Turkish  baths  or 
"bakings"  because  he  has  heard  of  some  friend  who  has  been 
benefited  by  some  such  plan  of  treatment,  and  we  venture  to 
assert  that  it  is  by  no  means  a  rare  occurrence  for  a  physician  to 
be  consulted  by  an  individual  whose  unguided  use  of  the  Turkish 
bath  has  resulted  in  cardiac  feebleness  or  vascular  disorders, 
wliich  are,  of  course,  chiefly  functional  rather  than  organic. 
In  certain  patients,  to  whom  at  first  glance  the  application  of 
heat  would  prove  advantageous,  a  more  careful  investigation 
reveals  the  fact  that  the  heart  is  so  dilated  and  feeble  that  such 
a  plan  of  treatment  woukl  not  only  be  harmful,  but  actually 
dangerous. 

We  have  seen  a  number  of  cases  of  this  kind  within  a  com- 
paratively short  time,  and  they  are  particularly  met  with  in 
persons  past  middle  life,  who  attribute  their  sufferings  to  gout 
or  other  diathetic  disorder,  and  in  men  and  women  who  attempt 
to  reduce  their  "flesh"  by  exposure  to  great  heat  and  profuse 
sweats,  with  the  result  that  they  produce  circulatory  weakness. 
As  a  matter  of  fact  the  first  class  would  be  more  benefited  by 
carefully  graduated  exercises  in  the  fresh  air,  in  order  that  impure 
materials  might  be  oxidized  rather  than  formed  and  then 
excreted  by  sweating.  In  the  second  class  there  is  a  failure  to 
recognize  that  the  laying  on  of  a  certain  amount  of  "flesh"  is  as 
natural  with  advancing  years  as  is  the  change  in  the  color  of  the 
hair  or  as  is  the  development  of  wrinkles  in  the  face.  Indeed, 
in  a  large  proportion  of  cases  a  gain  of  weight  is  indicative  of 
health  rather  than  disease,  and  he  or  she  who  attempts  to  meddle 
with  nature's  normal  processes  usually  meets  with  disaster.^ 

1  Therapeutic  Gazette,  August  15,  1909. 


VAPOR   OR   SWEATING   BATH  301 

THE  RUSSIAN  BATH  (DIAPHORETIC) 

In  this  the  patient  lies  on  a  marble  slab  in  a  small  room 
filled  with  steam.  He  is  rubbed  at  intervals  by  an  attendant 
to  hasten  perspiration.  The  temperature  of  the  room  is  lower 
than  in  the  hot  rooms  of  the  Turkish  bath,  the  presence  of 
steam  rendering  higher  temperatures  unbearable.  The  bather 
remains  in  this  room  from  ten  to  twenty  minutes.  After  this 
he  takes  a  shower  of  cold  water,  60°  F.  (15.6°  C),  or  a  plunge 
in  a  pool  at  the  same  temperature. 

Sweating  baths  on  much  the  same  principle  were  formerly 
practised  by  some  of  the  tribes  of  American  Indians  as  a  method 
of  treatment.  "These  baths  were  literally  earthen  ovens  into 
which  the  patient  crept  and  around  which  heated  stones  were 
placed  to  raise  the  temperature.  "When  the  patient  had  re- 
mained under  preparation  for  a  certain  time  he  was  taken  out 
and  immersed  in  cold  water."  ^ 

The  Finns  are  accustomed  to  take  steam  baths  prepared 
by  pouring  water  on  heated  stones,  after  which  they  rush  out, 
dripping  with  perspiration,  and  roll  in  the  snow  to  produce  a 
vigorous  reaction.  Currie  refers  to  this  practice  of  the  Finns, 
and  says  that  after  rolling  naked  in  the  snow  they  return  to 
their  hot  bath  as  before. 

VAPOR  OR  SWEATING  BATH 

To  apply  this  bath,  place  a  blanket  and  mackintosh  under 
the  patient  and  wrap  him  in  a  blanket.  Place  a  cradle  over  the 
patient  and  cover  it  with  a  mackintosh  and  blanket,  tucking 
them  in  well  around  the  neck  and  fastening  them  securely  at 
the  bottom  so  the  steam  cannot  escape.  Put  an  ice-cap  or  cold 
compress  to  the  head.  Let  the  steam  come  up  gradually  through 
a  spout  introduced  at  the  foot  of  the  bed  and  leading  from  a 
kettle  of  boiling  water.     Keep  the  patient  in  the  bath  for  from 

1  See  E.  M.  Rutteuber,  Memorial  History  of  the  City  of  New  York,  p.  41; 
Benjamin  Rush,  Natural  History  of  Medicine  Among  the  Indians;  Henry  R. 
Schoolcraft,  The  Indian  Tribes  of  the  U.  S.,  Phila.,  1851-55;  Stoll,  Reisen  in 
Guatemala;   Crevaux,  Travels  from  Cayenne  to  the  Andes;  see  also  p.  33. 


302 


HYDROTHERAPY 


thirty  minutes  to  one  hour,  or  as  required.  Watch  the  pulse 
at  the  temples  antl  the  face,  and  take  temperature,  pulse,  and 
respiration  in  the  bath. 


\'\'^.  94. — \'ai)or  or  sweating  bath  (Cohen). 

A  th(M-niometer  is  to  be  placed  in  the  bed,  and  the  steam 
continued  until  the  thermometer  registers  120°  F.  (48.9°  C.)  or 


Fig.  95. — Simple  arrangement  for  gi\'iiig  a  hot-vapor  bath  (Stoney). 

above,  when  the  steam  is  stopped  and  the  bather  is  treated  as 
after  the  hot  bath.     As  the  water  in  the  kettle  boils  down  it  must 


VAPOR   OR   SWEATING   BATH 


303 


be  replaced  by  hoiling  water,  not  by  hot  or  cold  water,  or  the 
steam  will  stop  until  the  water  boils  again.  Careful  watch 
must  be  kept  over  the  bather's  pulse,  which  can  be  taken  at  the 
temples. 

In  the  absence  of  an  oil-stove  or  a  spirit-lamp,  very  hot 
bricks,  smoothing-irons,  or  plates  may  be  wrapped  in  wet  flannel 
or  cloths;  the  hot  bricks  in  contact  with  the  wet  cloths  will 
make  steam.    The  cloths  must  be  placed  about  the  bather  on 


1 

m 

Uv 

^^^^^^^^^^^^^^^^^^^k^j 

•  1 

>-^^" 

■ 

Fig.  96. — Hot-air  cabinet  bath:  steam  radiation. 

plates  or  in  dishes  to  prevent  wetting  the  bed,  and  care  be 
taken  not  to  burn  the  bather.  The  bather  may  also  be  seated 
on  a  cane-bottom  chair,  the  clothing  being  removed,  and  sur- 
rounded with  blankets  or  comfortables,  which  must  be  fastened 
from  the  neck  down  (Fig.  96).  A  kettle  of  boiling  water  over 
a  spirit-lamp  or  an  oil-stove,  or  a  pan  or  pail  of  boiling  water, 
is  placed  under  the  chair.  The  feet  may  be  put  into  a  pail  of 
hot  water  to  increase  the  effect,  because  the  blood-vessels  of  the 
surface  of  the  body  are  dilated,  and  remain  so  while  the  heat  or 


304 


HYDHOTHEUAPY 


vapor  is  continued;  in  this  way  the  activity  of  the  skin  is  in- 
creased, the  pores  of  the  skin  are  opened,  and  perspiration  is 
produced.  The  attendant  shoukl  be  sure  that  the  bkankets 
or  coverings  are  fastened  closely  around  the  neck  and  about 


Fig.  97. — Hot-air  or  .steam  cabinet  (.T.  L.  Mott  Iron  Works). 

the  chair  to  prevent  the  steam  escaping.     The  bather  may  gen- 
erally be  allowed  to  have  plenty  of  water  to  drink. 


THE   ROMAN   BATH 

This  bath  is  simply  an  appUcation  of  massage  with  the  use 
of  unguents,  either  with  or  without  the  Turkish  bath. 

An  Irish -Roman  bath  depends  entirely  on  dry  hot  air  and 
the  consequent  induction  of  free  perspiration.  There  is  usually 
a  series  of  rooms  heated  to  various  degrees  of  temperature. 
The  anteroom  is  at  the  ordinary  temperature,  e.  g'.,  66°  to  68°  F. 
(18.9°-20°  C),  and  the  communicating  rooms  are  at  95°  to  104° 
F.  (35°-40°  C).  The  next  room  is  at  113°  to  122°  F.  (45°-50° 
C.)  and  the  fourth  room  at  149°  to  194°  F.  (65°-90°  C).  The 
bather  is  covered  only  with  a  bath-robe  and  wears  sandals  to 


THE   HOT-AIR   BATH    AND    THE   ELECTRIC-LIGHT   BATH      305 

protect  his  feet  from  the  hot  floor.  Sweating  usually  takes 
place  freely  before  reaching  the  last  room.  This  form  of  bath  is 
decidedly  inferior  to  the  use  of  the  hot-air  or  electric-hght 
cabinet. 

Give  plenty  of  water  to  drink. 

THE  HOT-AIR  BATH  AND  THE  ELECTRIC-LIGHT  BATH 

These  are  used  as  a  preliminary  treatment  before  applying 
douches.  The  entire  body,  with  the  exception  of  the  head,  is 
enclosed  in  a  cabinet  provided  with  steam  coils  or  electric  lights. 


Fig.  98. — Electric-light  bath    cabinet,  open;    seventy-two    16-candIepower  lamps 

(Max  J.  Walter). 

The  head  should  have  a  cold  turban  and  the  body  may  be  sur- 
rounded with  a  sheet  or  not,  as  desired.  The  heat  in  these 
cabinets  rises  to  140°  to  180°  F.  ('60°-82.2°  C.)  and,  as  a  rule, 
free  perspiration  is  produced  in  seven  to  twelve  minutes.  If 
electric  bulbs  are  used  perspiration  usually  results  in  less  time 
than  with  steam  radiation,  provided  the  heat  is  the  same. 

20 


300 


HYDROTHERAPY 


"The  superiority  of  the  hot-air  cabinet  over  tlic  ordinary 
Turkish  bath  is  evident.  The  patient  is  surrounded  by  liot 
air  in  the  cabinet  and,  the  head  being  free,  he  breathes  cooler 
air.  Not  only  is  he  thus  enabled  to  bear  higher  temperatures, 
but  he  is  free  from  dyspnea,  which  is  so  distressing  to  many  in  the 
hot-air  chamber  of  the  Turkisli  l)ath,  and  which  is  doubtless 
due  to  a  defective  supply  of  oxygen;  the  latter,  being  expanded 
by  heat,  is  not  breathed  in  sufficient  fjuantity  to  fulfil  its  physi- 


Fig.  99.— Electric-light  cabinet  (J.  L.  Mott  Iron  Works). 


ologic  function.  If  oxidation  be  the  chief  object  of  the  hot- 
air  bath,  the  cabinet  bath  must  be  far  superior  to  the  Turkish 
bath,  because  it  permits  a  more  abundant  supply  of  oxygen 
as  regards  the  temperature,  and  thus  facilitates  oxidation. 
Besides,  the  patient  is  not  subjected  to  the  admixture  of  emana- 
tions from  the  large  number  of  persons  who  often  occupy  the 
hot-air  chamber  simultaneously  in  the  Turkish  bath  establish- 
ments."^ 

Advantages  of  the  Electric-light  Cabinet  Over  that  Heated 
^Baxuch,  Hydrotherapy. 


THE   HOT-AIR   BATH   AND   THE   ELECTEIC-LIGHT   BATH      307 

by  Steam  Coils. — The  electric-light  cabinet  is  safer,  quicker  in 
action,  and  probably  has  a  greater  and  more  beneficial  effect  on 
the  underlying  tissues.  The  author  has  known  an  instance  in 
which  the  steam  coil  burst,  and  if  anyone  had  been  in  the  cabinet 
at  the  time  serious  injury  would  have  resulted.  We  would 
never  have  believed  such  an  accident  possible  unless  from  per- 
sonal observation.  The  steam  was  turned  on  under  high  pres- 
sure into  a  coil  which  was  not  known  to  be  defective,  but  was 
supplied  by  a  well-known  manufacturer. 

It  is  common  observation,  but  not  always  true,  that  perspira- 
tion ensues  in  an  electric-Ught  cabinet  more  quickly  than  in  the 
hot-air  cabinet. 

The  well-known  penetrating  quality  of  the  electric-light  rays 
probably  aids  metabolic  processes  in  the  deeper  structures. 
Dr.  Peck  states  this  proposition  as  follows: 

''These  conclusions  seem  to  be  well  founded  when  one  stops 
to  consider  the  physical  properties  of  the  tw^o  agents.  In  one 
case  the  body  is  heated  by  a  process  of  convection,  successive 
layers  of  tissue  being  heated  until  the  body  temperature  is 
raised  1  or  2  degrees;  while,  on  the  other  hand,  the  light  and  heat 
rays,  which  are  closely  related  in  physical  properties  to  sunlight 
rays,  penetrate  directly  the  tissues  and  produce  their  effects 
upon  the  metabolic  processes  by  directly  stimulating  the  normal 
body  activities.  We  are  coming  more  and  more  to  believe  that 
these  metabolic  processes  are  carried  on  through  the  intervention 
of  certain  enzymes  or  ferments,  and  exposing  the  body  to  the 
electric-light  rays  apparently  stimulates  these  fermentative 
processes  to  more  normal  activity."  ^ 

The  same  conclusions  would  be  true  of  cabinets  fitted  with 
incandescent  or  electric  arc  lights. 

It  is  interesting,  historically,  to  note  that  Aretseus  was  the 
first  to  recommend  that  the  head  should  be  excluded  in  giving 
vapor  baths;  and  it  was  he  who  advised  sulphur  baths  for  the 
cure  of  melancholy  and  leprosy. 

^  Yale  Medical  Journal,  May,  1909. 


308 


HYDROTHERAPY 


FOOT-BATH 

The  hot  foot-batli  is  the  best  and  most  important  of  the 
local  baths.  It  is  a  popular  method  of  treating  a  cold  in  its 
earliest   stnee   and   is   a   valuable   preventive   measure.'    Hot 

water  and  a  small  tub  or  pail  and  an 
additional  supply  of  very  hot  water  to 
reinforce  the  heat  of  the  bath  are  the 
only  means  retiuired;  although  it  may 
be  desirable  in  some  cases  to  add  a 
little  mustard  so  as  to  invite  the  flow 
of  blood  to  the  feet  and  ankles.  The 
temperature  of  the  water  may  be  grad- 
ually raised  to  110°,  115°,  or  120°  F. 
(43.3°,  46.1°,  or  48.9°  C.)  and  the 
duration  may  be  from  ten  to  fifteen 
minutes.  The  depth  of  the  water  may 
be  8  or  10  inches.  It  is  a  proper  pro- 
cedure after  the  initial  chill  of  pneu- 
monia. In  this  case  mustard  should  be 
added  to  the  bath,  which  should  be  given  in  bed  (see  p.  106). 
Sprains  of  the  ankle  or  foot,  bruises,  cramps  in  the  legs,  etc., 
are  not  only  rendered  much  less  painful  by  a  hot  local  bath, 
but  the  way  is  prepared  for  massage  and  permanent  dressings. 


Fig.  100.— The  leg-bath 
(Luke). 


MEDICATED  OR  MODIFIED  BATHS 

Sulphur  baths  may  be  prepared  at  home  according  to  the 
following  formula,  which  is  sufficient  for  a  bath  of  30  gallons : 

Precipitated  sulphur 2  ounces. 

Sodium  hyposulpliitc 1  ounce. 

Dilute  sulphuric  acid J      " 

Water 1  pint. 


The  above  ingredients  should  be  mixed  together  and  then 
added  to  the  bath. 

Warm  Mustard  Bath. — A  modification  of  this  bath  has  re- 


MEDICATED   OR  MODIFIED   BATHS  309 

cently  been  recommended  by  0.  Heubner/  who  has  used  it 
with  great  success  in  the  capillary  bronchitis  of  young  children 
and  in  the  suffocative  attacks  which  are  marked  in  weak  rachitic 
children.  About  3  pints  of  warm  water  are  placed  in  an 
open  vessel  and  1  pound  of  mustard  meal  is  added  and  stirred 
until  the  thin  mixture  emits  the  irritating  fumes  which  cause 
smarting  of  the  eyes.  Then  a  Unen  cloth,  of  sufficient  length 
to  cover  the  child,  is  saturated  with  the  mixture  and  wrapped 
about  the  child,  who  is  then  covered  with  a  woolen  blanket 
reaching  to  the  neck.  After  ten  or  fifteen  minutes  the  child 
will  complain  of  discomfort,  and  as  the  wrappings  are  removed 
the  skin  shows  marked  reddening.  The  child  is  then  washed 
in  warm  water  and  placed  in  an  ordinary  warm  wet  pack  and 
allowed  to  remain  for  one  or  two  hours.  This  produces  diapho- 
resis. After  the  pack  the  child  is  put  in  a  warm  bath  which 
is  gradually  cooled.  He  is  dried  and  allowed  to  remain  quiet 
the  remainder  of  the  day. 

One  advantage  of  this  method  is  that  the  irritating  fumes 
of  the  mustard  are  not  inhaled  and  that  the  reaction  is  more 
perfect. 

A  simple  form  of  mustard  bath  is  composed  of  potassium 
sulphid  1  ounce  to  7  gallons  of  hot  water. 

An  alkaline  bath  may  be  made  by  adding  1  ounce  of  sodium 
bicarbonate  to  every  5  gallons  pf  water. 

Pine-needle  Bath. — This  may  be  used  with  the  vapor  cabinet. 
An  ounce  of  pine-needle  oil  (oleum  pini  sylvestris)  is  placed  in 
the  vapor  pan  with  3  ounces  of  water.  The  patient  is  then 
steamed  for  twenty  or  thirty  minutes  in  the  cabinet;  during 
this  time  perspiration  is  profuse.  Afterward  massage  may  be 
given.  Baths  may  be  medicated  with  pine-needle  extract,  2 
ounces  to  40  gallons.^ 

*  Therapie  der  Gegenwart,  January,  1905. 

^  Langbein's  coniferol  tablets  may  be  obtained  of  the  Hygienic  Resorts 
Bureau,  Chancery  Lane,  W.  London.  See  also  under  Dr.  Zucker's  Carbon- 
ated Bath,  p.  313. 


310  HYDROTHERAPY 

"NAUHEIM^  BATHS;  CARBONATED  BATHS;  ACID 
BATHS  (KISCH);  EFFERVESCING  BATHS 

The  Nauheim  bath  depends  on  the  presence  of  carbon  dioxid 
with  other  chemicals,  principally  sodium  chlorid  and  calcium 
chlorid,  in  various  degrees  of  solution.  The  natural  baths  are 
given  par  excellence  at  Bad  Nauheim  in  tlic  Grand  Duchy  of 
Hesse,  near  Frankfort,  in  Germany,  near  the  southern  foot  of 
the  Taunus  Mountains.  (See  pages  134  and  221.)  The  growing 
popularity  of  Nauheim  is  shown  by  the  presence  of  30,000 
visitors  in  1907,'  but  the  greatest  tribute  to  their  efficacy  is  a 
widespread  effort  to  prepare  these  baths  artificialh''  and  a^•oid 
the  long  journey  to  Nauheim.  The  class  of  cases  for  which  the 
treatment  is  sought  renders  it  all  the  more  desirable  that  the 
forms  of  treatment  practised  at  Nauheim  be  provided,  if  pos- 
sible, at  home. 

The  season  at  Nauheim  is  from  May  15  to  October  1.  During 
hot  weather  patients  can,  as  a  rule,  take  a  bath  at  a  lower  tem- 
perature than  when  it  is  cold ;  they  can  also  take  an  effervescing 
bath  at  a  lower  temperature  than  a  bath  in  still  water,  the 
presence  of  carbonic  acid  gas  counteracting  the  feeling  of  cold,  yet 
not  interfering  with  the  circulatory  reaction  as  in  the  case 
of  still  water  at  a  corresponding  temperature.  Dr.  Thorne 
usually  lets  the  patient  have  a  hot-water  bottle  in  bed  after 
the  bath  unless  the  weather  should  be  very  warm.  If,  how- 
ever, the  patient  still  does  not  remain  comfortably  warm,  he 
regards  it  as  an  indication  for  raising  the  temperature  of  the 
bath.  It  is  noted  that  a  bath  which  would  produce  coldness 
and  cj'^anosis  of  the  extremities  at  the  commencement  of  the 
course  is  usually  productive  of  a  sense  of  warmth  and  comfort, 
and  a  marked  improvement  of  color  toward  the  end  of  the  treat- 
ment ;  this  is  evidence  of  improved  reaction  and  circulation. 

If  patients  have  rigors,  the  baths  are  too  long  or  too  strong 
or  perhaps  they  should  be  suspended.  These  rigors  may 
occur  even  when  the  extremities  are  warm  and  of  good  color. 

1  In  1907  419,277  baths  were  given.   In  1909  about  35,000  visitors  were  recorded. 


ARTIFICIAL  NAUHEIM   BATHS  311 

If  they  occur  at  the  outset,  they  will  probably  decrease  as  suc- 
cessive baths  are  given,  and  are  not  always  a  serious  indication. 

Aside  from  the  associated  forms  of  treatment,  such  as  re- 
sisted (Schott)  movements,  graded  walks,  diet  regulations,  and 
the  benefits  of  climate,  the  baths  are  given  at  Nauheim  accord- 
ing to  a  gradual  increase  in  strength  as  regards  solid  and  gaseous 
contents;  this  is  a  distinguishing  feature.  The  temperature  of 
the  three  springs  used  at  Nauheim  are  85°  F.  (29.4°  C),  90°  F. 
(32.2°  C),  and  95°  F.  (35°  C).  The  duration  of  the  baths  is 
short,  four  to  ten  minutes  as  a  rule.  The  three  types  of  baths 
are  as  follows :  ^ 

The  first  and  mildest  type,  the  so-called  thermal  baths,  are 
obtained  by  admitting  the  water  to  large  reservoirs,  where  in 
contact  with  the  atmosphere  the  CO,  escapes  and  the  calcium 
and  iron  salts  precipitate.  These  salts  color  the  water  yellowish 
brown. 

The  second  type,  containing  a  little  moreCOa,  is  the  thermal 
sprudel  hath,  and  is  obtained  by  conducting  water  to  subterranean 
air-tight  tanks,  from  which  it  is  conveyed  to  bathing  tubs.  This 
water  is  clear  or  slightly  yellow,  having  lost  but  a  proportion 
of  its  CO^. 

The  third  grade,  or  effervescing  type,  is  known  as  the  sprudel 
haths,  and  contain  the  full  amount  of  COj.  In  their  natural 
state  the  waters  contain  from  550  to  1300  cc.  of  CO2  to  the  liter, 
but,  of  course,  much  of  this  instantly  escapes  as  soon  as  the 
water  reaches  the  tub.  These  baths  are  strongly  effervescing, 
bright,  sparkling,  and  clear  as  crystal. 

Clear  brine  baths,  containing  3  per  cent,  of  chlorids  and  no 
gas,  are  also  used. 

ARTIFICIAL  NAUHEIM  BATHS 

These  are  quite  extensively  used  and  some  advantages  are 

claimed  by  those  who  have  taken  the  trouble  to  apply  them  in 

selected  cases  according  to  a  definite  scheme  of  graduation.     In 

^  See  description  by  Paul  C.  Franze,  M.  D.,  in  an  address  before  the  Hun- 
terian  Society  of  London,  March  23,  1904.  Also  article  on  Bad  Nauheim,  by 
J.  H.  Honan,  M.  D.,  Illinois  Medical  Jour.,  April,  1910. 


312  HYDROTHERAPY 

America,  Dr.  Thomas  E.  Satterthwaite  and  Dr.  C.  N.  B.  Camac, 
of  New  York,'  and  Dr.  J.  M.  Anders,  Dr.  S.  Solis  Colien,  and 
Dr.  James-  Tyson,  of  Philadelphia,^  and  Dr.  Philip  K.  Brown, 
of  San  Francisco,^  have  endeavoretl  to  place  tliis  form  of  treat- 
ment on  a  tlefinite  and  effective  basis.  The  necessary  salts 
can  be  obtained  in  the  most  convenient  form  from  several  manu- 
facturers and  the  use  of  cakes  of  acid  sodium  sulphate  as  furnished 
by  them  is  far  j^referable  to  the  hydrochloric  acid  wliich  was 
previously  used  for  the  acid  element  in  the  bath.  The  latter 
is  liable  to  destroy  the  tubs  and  injure  the  patient.  It  further- 
more yields  a  very  uneven  effervescence  and  is  hard  to  regulate.* 
The  box  of  the  Cassebeer  Co.  contains  8  disks  of  acid  sodium  sul- 
phate each  of  1]  lbs.,  wrapped  in  heavy  lead  foil,  and  four  2-lb. 
packages  of  sodium  bicarbonate.  The  method  of  preparing 
the  bath  is  as  follows : 

Fill  a  porcelain  or  enameled  tub  with  50  gallons  of  water  at 
105°  F.  (40.6°  C).  The  required  amount  of  bathing  salt  is 
then  added.  This,  in  an  ordinary  Nauheim  bath,  should  consist 
of  from  2  to  3|  per  cent,  of  a  mixture  of  sodium  chlorid  and 
calcium  chlorid.  In  the  stronger  baths  the  imported  concen- 
trated salts,  the  Mutterlauge  of  Nauheim,  is  added  to  this  mixture. 
It  contains  about  75  per  cent,  of  calcium  chlorid  and  may  be 
added  to  the  bath  at  about  the  middle  of  the  course.  This  Mut- 
terlauge is  not  a  natural  ingredient  of  any  of  the  springs  except- 

^  International  Clinics,  vol.  i,  Thirteenth  Series,  1903. 

"Trans.  Philadelphia  County  Medical  Society,  January  31,  1905. 

3  California  State  Journal  of  Medicine,  April  1,  1907. 

*  Standard  packages  containing  cakes  of  acid  sodium  sulphate  and  pack- 
ages of  sodium  bicarbonate  are  supplied  by  the  Shepard  Pharmacal  Co.,  275 
Water  Street,  New  York,  and  Schieffelin  &  Co.,  New  York.  If  the  prepared 
salts  are  not  accessible,  the  elements  may  be  prepared  as  follows:  Take 
sodium  carbonate,  l\  lbs.;  sodium  bicarbonate,  J  lb.;  calcium  chlorid,  3  lbs.; 
sodium  chlorid,  2  lbs.  Mix  and  dis.'^ohe  in  the  bath  and  add  slowly  the 
sodium  bisulphate,  1  lb.,  which  should  be  kept  by  itself.  This  gives  a  bath  of 
moderate  strength.  In  order  to  avoid  the  objectionable  features  of  acid 
sodic  sulphate  vise  is  made  of  a  solution  of  formic  acid.  "  Dr.  Zucker's 
carbonated  bath"  and  the  "ZeO,  bath"  depend  on  the  action  of  formic 
acid  on  sodium  bicarbonate  (see  p.  314).  Tlie  author  prefers  "Dr.  Zucker's 
bath  "  to  any  of  the  others.     Tiiis  batli  cannot  corrode  tubs  or  fixtures. 


ARTIFICIAL   NAUHEIM    BATHS  313 

ing  to  a  very  small  extent,  but  is  a  by-product  of  neighboring 
chemical  works  and  is  used  at  Nauheim  to  stimulate  the  skin 
and  increase  and  prolong  the  effect  of  the  carbonic  acid  gas 
effervescence.  Th  attendants  and  the  patients  themselves 
duly  value  this  addition  to  the  bath.  It  is  quite  extensively 
exported  from  Nauheim  for  use  where  artificial  Nauheim  baths 
are  given. 

The  artificial  package  is  generally  faulty  in  wholly  omitting 
both  calcium  chlorid  and  sodium  chlorid,  although  the  latter 
can  easily  be  obtained.  The  reason  they  are  omitted  is  on 
account  of  the  additional  weight  of  the  common  salt  and  the 
additional  cost  of  calcium  chlorid  and  magnesium  chlorid. 
The  calcium  chlorid  is  difficult  to  handle  in  a  solid  form  on 
account  of  its  irritating  qualities  and  its  strong  affinity  for 
water.  The  acid  sodium  sulphate  likewise  must  be  kept  in  a  very 
dry  place,  otherwise  it  is  sure  to  crumble,  the  free  sulphuric  acid 
eating  its  way  through  the  container,  ruining  the  soda  or  other 
neighboring  objects.  Naturally  the  efficiency  of  the  bath  cannot 
be  insured  with  deteriorated  contents. 

Precautions. — ^The  Triton  Co.  offers  the  following  precau- 
tions as  to  the  hath-tuh:  In  order  to  prevent  any  injury  to  the 
bath-tub  by  contact  with  the  acid  cakes  there  are  three  methods 
of  procedure :  First,  allow  each  cake  to  rest  on  the  lead  foil  pro- 
vided in  the  boxes;  second,  use  three  or  four  ordinary  saucers  and 
place  the  cakes  on  them;  third,  use  a  piece  of  rubber  sheeting 
sufficient  to  cover  the  bottom  of  the  bath-tub  and  put  the  cakes 
on  the  sheeting.  The  use  of  the  rubber  sheeting  is  advised  as 
the  most  efficient  and  reliable  method  of  protection. 

Always  allow  the  cakes  to  dissolve  entirely  before  drawing 
off  the  water  from  the  tub.  The  water  is  alkaline  and  will  not 
injure  the  drain-pipes. 

Dr.  Zucker's  Carbonated  Bath. — Under  this  name  packages 
have  been  prepared  by  Max  Elb,  of  Dresden,  Germany,  and 
introduced  into  the  United  States  and  England.  This  process 
of  preparing  artificial  carbonic  acid  baths  depends  on  the  use 
of  formic  acid  in  solution  and  bicarbonate  of  soda  enclosed  in 


314  HYDROTHERAPY 

gauze  bags.  A  sufficient  quantity  of  SO  per  cent,  commercial 
formic  acid  in  a  i)int  bottle  is  poured  into  a  bath  of  40  gallons 
of  water  at  95°  F.  (35°  C),  The  patient  enters  the  bath  and 
during  the  first  half  of  the  allotted  time  gently  applies  the  bags 
or  cushions  containing  the  sodium  bicarbonate  to  the  trunk 
and  limbs.  Carbonic  acid  gas  is  immediately  generated  in 
the  neighborhood  of  the  alkali  and  soon  permeates  the  entire 
bath.  During  the  latter  half  of  the  bath,  which  is  intended 
to  occupy  in  its  entire  duration  from  fifteen  to  thirty  minutes, 
the  subject  should  rest  quietly  and  allow  the  entire  body  below 
the  neck  to  be  subject  to  the  action  of  the  contained  gas.  To 
render  this  package  complete,  3  or  4  pounds  of  common  salt 
and  3  or  4  ounces  of  calcium  chlorid  should  be  added.  The 
formic  acid  supplied  was  analyzed  by  the  author  and  found  to 
be  of  specific  gravity  1.18  and  free  from  hydrochloric  acid. 

These  baths  are  furnished  in  five  forms :  The  single  carbonic 
acid  bath;  the  carbonic  acid  chalybeate  bath;  carbonic  acid 
bath  with  pine-needle  extract;  chalybeate  with  pine-needle 
extract;  with  various  aromatic  herbs,  essences,  and  extracts, 
such  as  lavender,  chamomile,  thyme,  sage,  etc.;  15  minims 
of  an  ethereal  oil  or  from  2  to  4  ounces  of  an  alcoholic  extract 
are  sufficient  for  a  bath.^ 

The  author  tested  this  bath,  and  found  no  unpleasant  effects 

*  Descriptions  of  these  baths  and  their  physiologic  action  may  be  found 
in  the  following  references:    Deutsche  medicinische  Wochenschrift,  No.  3, 

1905,  p.  107;  Miinchner  medicinische  Wochenschrift,  No.  5,  1905,  p.  236; 
Medicinische  Klinik,  Heft  9,  1905,  p.  273;  Pharmaceuti.sche  Centralhalle,  vol. 
V,  January,  1905,  p.  5;  Pharmaceutische  Zeitung,  vol  xi,  January,  1905,  p. 
30;  Neueste  Erfindungen  und  Erfahrungen,  part  3,  Heft,  1905,  p.  127;  Siid- 
deutsche  Apotheker-Zeitung,  vol  xvii,  February,  1905,  p.  112;  Pharmaceu- 
tische Zeitung,  vol.  xxv,  February,  1905,  p.  167;  Die  medicinische  Woche,  No. 
11,  vol.  xiii,  March,  1905,  p.  87;  Medico,  No.  4,  1905,  p.  62;  Zeitschrift  fur 
Krankenpflege,  February,  1905,  p.  72;  Zeitschrift  fur  Krankenpflege,  October, 

1906,  p.  397;  Deutsche  Aerzte-Zeitung,  No.  23,  vol.  1,  December,  1907; 
Russische  Medicinische  Rund.schau,  No.  5,  1907;  Therapeuti.sche  Rundschau, 
No.  3,  January,  1908;  Herman  C.  Riggs,  Medical  Times,  April,  1910. 

In  the  United  States  the  packages  may  be  obtained  of  George  B.  Evans, 
Philadelphia,  and  The  Smith,  Kline  and  French  Co.,  429  Arch  Street,  Phila- 
delphia. 


ARTIFICIAL    NAUHEIM    BATHS  315 

on  the  skin  and  no  injury  to  a  porcelain  tub.    An  agreeable 
stimulation  and  slight  reddening  of  the  skin  was  noted. 

In  Great  Britain  packages  known  as  Sandow's  and  the 
Croyden  are  used.  The  former  contain  4  packets  of  sodium 
bicarbonate  and  8  tablets  of  acid  sodium  sulphate.  They  are 
prepared  so  that  8  parts  of  the  sodium  bicarbonate  exactly 


Fig.  101. — The  Fischer-Kiefer  COj  generator  for  Nauheim  bath  (Luke). 

neutralize  12  parts  of  the  acid  sodium  sulphate.     The  alkali 
should  be  a  little  in  excess. 

Apparatus  for  generating  carbonic  acid  gas  and  mixing  it 
with  the  water  have  been  devised;  one  of  the  best  is  probably 
that  known  as  the  Fischer-Kiefer  Company's  generator  and  is 
made  in  Zurich  (Fig.  101).  Similar  apparatus  is  made  by  the 
Electritats  gesellschaft  Sanitas,  Friedrich  Strasse,  131  d.;  Berlin, 


316 


HYDROTHERAPY 


N.  (Fig.  102).     Another  is  made  by  the  Kny-Scheerer  Co.,  of 
New  York  (Fig.  103). 

If  sea-water  be  accessible,  it  may  be  used  for  the  artificial 
Nauheim  bath  Besides  the  chlorids,  sea-water  contains  bromids, 
both  of  which  add  to  the  efficacy  of  the  bath.  At  the  Hotel 
Chamberlin,  at  Fortress  Monroe,   N'irginia,  sea-water  is  thus 


!     '■  ^  — 


Fig.  102. — Carbonic  acid  apparatus.     Fig.  103. — Carbonic  acid  gas  mixing  device 

for  Nauheim  baths. 

utilized  and  the  carbonic  acid  gas  under  pressure  is  thoroughly 
mixed  with  the  water  by  means  of  an  electrically  driven  ap- 
paratus. 

Satterthwaite  Method  of  Giving  Nauheim  Baths. — Dr.  Sat- 
terthwaite  has  formulated  an  excellent  scheme  for  the  six 
weeks'  course  of  35  graduated  baths  which  will  prove  useful  in 
practice : 


ARTIFICIAL   NAUHEIM   BATHS  317 

First  week  (No.  1  hath),  J  per  cent,  plain  warm  salt  bath 
(2  pounds  of  bathing  salt  to  50  gallons  of  warm  water).  Tem- 
perature 98°  F.  (36.7°  C).  Duration  four  minutes.  Intermis- 
sion on  the  third  and  sixth  days  of  this  week. 

Second  week  (No.  ^  bath),  f  per  cent,  warm  salt  bath  (3 
pounds  of  bathing  salt  to  50  gallons).  Carbonic  acid  gas  | 
per  cent.  (2  disks  acid  sodium  sulphate  to  1  package,  2 
pounds  sodium  bicarbonate).  Temperature  97°  F.  (36.1°  C). 
Duration  six  minutes.  Intermission  on  the  fourth  day  of  this 
week. 

Third  week  (No.  3  bath),  1  per  cent,  warm  salt  bath  (4 
pounds  of  bathing  salt  to  50  gallons).  Temperature  96°  F.  (35.6° 
C).  Carbonic  acid  gas  J  per  cent.  (4  disks  in  2  packages). 
Duration  eight  minutes.     Intermission  on  the  fourth  day. 

Fourth  week  (No.  4-  bath),  1\  per  cent,  warm  salt  bath  (5 
pounds  bathing  salt  to  50  gallons).  Nauheim  concentrated 
brine  salt  (Miitterlauge  salts),  8  ounces,  or  h  pint  of  the  liquid 
salts,  CO2  f  per  cent.  (6  discs  to  3  packages).  Temperature  95° 
F.  (35°  C).  Duration  ten  minutes.  Intermission  on  the 
fourth  clay. 

Fifth  week  (No.  5  bath),  Ih  per  cent,  warm  salt  bath  (7 
pounds  bathing  salt  to  50  gallons).  Miitterlauge  salts,  f  pint; 
CO2,  I  per  cent.  (6  disks  to  3  packages).  Temperature  94°  F. 
(34.4°  C).  Duration  twelve  minutes.  Intermission  on  the 
fifth  day. 

Sixth  iveek  (No.  6  bath),  2  per  cent,  warm  salt  bath  (10 
pounds  of  bathing  salt  to  50  gallons).  Miitterlauge,  1  pint;  CO2 
1  per  cent.  (8  disks  to  4  packages).  Temperature  93°  F.  (33.9° 
C).  Duration  fourteen  minutes.  Intermission  on  the  fifth 
day. 

In  the  case  of  robust  people  we  may  commence  with  No.  2 
bath,  or  in  the  case  of  a  dehcate  person  it  may  be  best  not  to 
exceed  the  strength  of  No.  4  bath. 

In  preparing  the  bath  the  best  way  is  to  draw  about  20 
gallons  of  hot  water  in  the  tub.  A  tub  5  feet  long  will  then  be 
filled  to  a  depth  of  6  inches.     The  sodium  chlorid  is  then  dis- 


318  HYDROTHERAPY 

solved  and  well  distributed,  and  if  the  Miitterlauge  is  to  be  used 
it  is  thoroughly  diffused  through  the  bath.  If  cakes  of  acid  sul- 
phate are  to  be  used  they  are  now  broken  with  a  hammer  and  laid 
on  the  accompanying  lead  foil,  and  the  bicarbonate  is  laid  on  top, 
2  disks  to  1  package.  The  water  is  now  drawn  in  the  bath  so 
that  the  50  gallons  shall  have  a  temperature  as  designated, 
98°  F.  (36.7°  C.)  for  No.  1  bath,  or  93°  F.  (33.9°  C.)  for  No.  6 
bath.  The  alkaline  and  acid  salts  are  then  lowered  on  their 
leaden  foils  at  places  along  the  bottom  of  the  tub.  Effervescence 
begins  at  once  and  may  take  eight  or  ten  minutes  for  completion. 
It  is  best  to  start  with  water  a  little  above  the  requisite  tem- 
perature to  allow  for  cooling,  and  the  lead  and  any  undissolved 
sulphate  should  be  removed  before  the  patient  enters.  If  for- 
mic acid  is  used,  as  described  on  pages  313  and  314,  the  prep- 
aration of  the  bath  is  simpler. 

Massage  may  be  employed  in  the  bath,  after  which  the 
patient  is  carefully  dried  with  warm  towels  and  put  to  bed,  or 
the  patient  should  rest  at  least  for  an  hour. 

The  effect  of  the  baths  at  Naulieim  and  of  the  artificial  baths 
is  principally  on  the  heart  and  blood-vessels.  The  resistance 
movements  which  have  been  systematized  by  Professor  Theo- 
dore Schott  and  his  brother,  the  late  Dr.  August  Schott,  are  con- 
sidered by  many  an  essential  feature  of  the  treatment  and  are 
most  thoroughly  carried  out  at  Nauheim,  supplemented  by  the 
terrain  km,  or  graduated  walks  on  the  hillside  (Oertel  System). 

The  immediate  effect  of  the  first  bath  is  a  diminished  pulse- 
rate,  intensified  heart  sounds,  and  in  a  case  of  extreme  cardiac 
dilatation,  probably  a  reduction  of  the  size  of  the  heart  and  its 
cavities.  This  has  been  noted  by  competent  observers  after  a 
single  bath.  While  this  is  not  always  maintained,  each  suc- 
ceeding bath  leaves  the  organ  a  little  smaller  than  in  the  pre- 
vious one,  and  thus  compensation  is  finally  restored,  in  most 
cases  at  least. 

The  effect  of  carbonated  baths  on  an  intermittent  heart,  with 
palpitation  following  severe  diphtheria  and  augmented  by 
tobacco,  constitutes  the  subject  of  an  interesting  personal  ob- 


ARTIFICIAL   NAUHEIM    BATHS  319 

servation  by  Dr.  Philip  King  Brown.  At  the  time  the  baths 
were  begun  the  patient  was  thirty-six  years  of  age  and  tobacco 
had  not  been  used  for  a  month.  The  heart,  nevertheless,  was 
omitting  every  third  or  fourth  beat  and  the  rate  was  between 
90  and  100.  The  blood-pressure  was  120  with  Stanton's  sphyg- 
momanometer. Two  courses  of  Nauheim  baths  were  given, 
with  20  in  each  series,  and  a  ten  days'  intermission  between  them. 
In  the  first  series  resisted  movements  followed  the  baths  for 
twenty  minutes.  In  the  second  series  they  preceded  the  baths. 
After  the  first  five  baths  the  heart  would  frequently  beat  fifty 
or  sixty  times  without  any  intermission.  The  rate  for  some 
hours  after  treatment  fell  15  to  20  beats,  reaching  normal  at 
the  end  of  the  fifth  bath.  From  that  time  on  the  pulse  varied 
from  72  to  80,  being  brought  down  sometimes  to  68  after  treat- 
ment. The  second  series  of  baths  was  carried  out  to  study  the 
effect  of  movements  given  before  the  baths. 

In  this  particular  instance  it  was  shown  that  resisted  move- 
ments had  the  same  effect  as  the  bath,  but  on  evenings  when  they 
were  not  followed  by  the  bath  the  effect  was  not  as  lasting  by 
several  hours.  It  was  noted  that  exhaustion  after  work  which 
preceded  the  first  baths  and  which  began  to  show  itself  after 
the  first  series,  was  definitely  relieved  after  the  second  series. 

Dr.  Brown  has  also  studied  in  his  own  person  the  effect  of 
the  various  elements  of  the  Nauheim  bath  and  has  furnished 
the  mean  of  the  observations  made  during  two  years.  A  fifteen- 
minute  warm  bath,  94°  to  98°  F.  (34.4-36.7°  C),  lowered  the 
pressure  on  an  average  of  15  mm.;  pulse-rate  varies  little  or 
nothing. 

A  fifteen-minute  strong  NaCl  bath,  7  pounds  to  40  gallons, 
94° to  98°  F.  (34.4°-36.7°  C),  lowered  the  pressure  10  to  15  mm.; 
the  pulse  may  be  slightly  slowed. 

A  fifteen-minute   calcium-chlorid   bath,    IJ   pounds   to  40 

gallons,  94°  F.  (34.4°  C.)  temperature,  raised  the  pressure  15 

mm.     This  is  true  even  if  the  pressure  has  been  raised  already 

by  food  taken  a  short  interval  before. 

.  A  fifteen-minute  mustard  bath,  IJ  pounds  to  40  gallons, 


320  HYDROTHERAPY 

94°  F.  (34.4°  C),  had  the  same  effect  as  a  warm  bath,  lowering 
the  pressure  15  mm.,  without  altering  the  i)ulse.  The  skin 
was  scarcely  reddenetl. 

Three  pounds  of  mustard  in  a  bath  of  94°  F.  (34.4°  C.)  tem- 
perature, given  for  ten  minutes,  or  the  weaker  mustard  bath, 
with  vigorous  friction  applied  to  the  skin,  has  the  effect  of 
raising  the  pressure,  and  reddening  the  skin  markedly  for  an 
hour  or  more.  A  fifteen-minute  full  strength,  alkaline  effer- 
vescent Nauheim  bath  at  86°  to  94°  F.  (30°-34.4°  C),  raised  the 
pressure  rapidly  during  the  first  half  of  the  bath,  and  more 
slowly  during  the  last  half,  making  it  altogether  about  20  mm. 
This  effect  lasts  during  the  daytime  about  four  hours.  When 
the  bath  is  taken  at  night,  11  p.  m.,  the  pressure  on  the  following 
morning  at  7  a.  m.  is  not  as  low  as  normal  by  5  to  10  mm.,  show- 
ing that  the  usual  drop  through  the  sleeping  hours  is  not  as 
marked  as  is  normal. 

Dr.  Brown  records  several  cases  of  fatty  infiltration  of 
the  heart  with  obesity  successfully  treated  by  Nauheim  baths 
and  the  von  Noorden  anti-obesity  tliet. 

Regime  at  Nauheim. — At  Nauheim  the  patient  is  usually 
up  at  6.30  or  7  a.  m.  and  as  soon  as  dressed  starts  for  the 
springs  to  drink  the  water.  After  al)out  an  hour  he  returns 
for  breakfast,  rests  an  hour  or  more,  and  then  goes  out  again 
for  his  bath.  He  returns  to  his  hotel  and  rests  for  another 
hour  in  bed  or  until  nearly  lunch  time.  In  the  afternoon  he 
drives  or  takes  other  outdoor  exercise,  according  to  the  advice 
of  his  physician,  but  the  rest  in  bod  forms  a  large  part  of  the 
usual  routine  of  treatment.'     (See  p.  133.) 

The  Effect  of  Hot  and  Cold  Baths  on  the  Size  of  the  Heart.— 
Since  Moritz-  introduced  the  method  of  measuring  the  dimen- 
sions of  the  heart  by  means  of  the  orthodiagraph  comparative 
measurements  arc  for  the  first  time  possible,  and,  in  competent 

'  In  London  artificial  Nauheim  baths  are  provided  at  The  St.  George's 
Nauheim  Institute,  6  George  Street,  Hanover  Square,  W.;  in  Boston  and 
Philadelphia,  at  the  Medical  Baths;  and  at  various  Medical  Baths  or  Hydri- 
atric  Institutes  in  Boston,  New  York.  Pliiladelphia,  Chicago,  and  other  ciiies. 

2  Miinchener  Med.  Woch.,  1900,  No.  29. 


ARTIFICIAL    NAUHEIM    BATHS  321 

hands,  it  would  seem  to  be  a  fairly  precise  instrument.^  The 
original  model  has  been  greatly  improved  by  Hoffmann,  Lev}^- 
Dorn,  and  Groedel.^  There  are  very  few  of  these  instruments 
in  the  United  States.  The  x-Tay  tube  and  the  sheet  of  paper 
for  marking  the  cardiac  boundaries  are  attached  to  movable 
arms  acting  at  exactly  the  same  relative  distance  on  opposite 
sides  of  the  patient  and  moving  harmoniously.    By  an  ingenious 


Fig.  104. — Orthodiagraph. 

contrivance  the  heart's  area  can  be  traced  by  means  of  an 
attached  fluoroscope  and  the  record  made  automatically  on  the 
paper  for  future  comparison.  This  is  infinitely  superior  to  the 
previous  method  of  percussion  or  auscultator}'-  percussion  and 
is  the  basis  of  conclusion  which  Moritz,  August  Hoffman,  Rudolf 

^  Manufactured  by  Reiniger,  Gebbert  and  Schall,  at  Erlangen,  Germany, 
and  also  by  Electricitatsgesellschaft  "Sanitas,"  Berlin,  No.  24,  Friedrich- 
strasse,  131  d.     Price  about  $156.00  to  $125.00. 

'Franz  M.  Groedel,  Orthorontgenographie,  Munich,   1908.     Also    "Die 
Orthodiagraphie,"  Dr.  Karl  Francke,  Munich,  1910. 
21 


322  HYDROTHERAPY 

and  Beck,*  and  the  Groedels  of  Nauheira  have  drawn  as  to  the 
effect  of  baths  on  the  heart. 

In  ordinary  ratliographs  the  shadow  of  the  heart  or  of  any 
internal  organ  is  necessarily  larger  than  its  natural  size  as  the 
rays  from  the  anticathode  of  the  Crookes  tube  are  projected 
from  a  point  in  the  shape  of  a  cone;  but  with  the  orthodiagraph 
the  source  of  the  Rontgen  rays,  the  center  of  the  fluorescent 
screen,  and  the  pneumatic  pen  are  kept  always  in  line.  The 
arms  supporting  these  parts  of  the  instrument  are  attached  to  a 
carriage  which,  while  allowing  all  motions  in  one  fixed  plane, 
will  keep  this  straight  line  perpendicular  to  the  plane.  Thus 
the  pencil  of  rays  coming  from  the  tube,  through  a  small  aperture 
in  a  lead  diaphragm  to  the  center  of  the  screen,  while  it  may  be 
moved  over  a  considerable  surface,  will  always  occupy  parallel 
positions.^ 

Rudolf  and  Beck  reported  that  in  all  the  patients  they 
studied,  the  size  of  the  heart  was  measured  immediately  before 
the  baths,  and  the  operation  was  repeated  as  soon  after  the  bath 
as  circumstances  permitted,  the  time  between  the  end  of  the 
bath  and  the  estimation  of  the  changes  in  the  heart  not  exceed- 
ing two  or  three  minutes.  The  results  obtained  were  quite 
uniform.  The  effect  of  the  hot  bath  was  to  diminish  the  size 
of  the  heart,  the  amount  of  the  change  being  quite  considerable 
in  most  cases.  In  one  case  the  heart  remained  unchanged  in  size. 
The  effect  of  the  cold  bath  was  to  increase  the  size  of  the  heart, 
no  change  being  noticed  in  one  case  only.  The  diminution  in 
the  size  of  the  heart  after  hot  baths  was  accompanied  by  an  in- 
crease in  the  rapidity  of  the  pulse  and  in  the  supply  of  blood  to 
the  skin,  phenomena  which  are,  of  course,  commonly  observed 
after  hot  bathing.  Cold  baths,  on  the  other  hand,  were  followed 
by  increased  pallor  of  the  skin  and  diminution  in  the  frequency 
of  the  pulse.     The  limited  number  of  cases  examined  does  not 

1  Munchener  Med.  Woch.,  January  26,  1909. 

^  See  Orthodiagraphy  in  the  Study  of  tlie  Heart  and  Great  Vessels,  by 
Thomas  A.  Claytor  and  Walter  H.  Merrill,  Trans.  Association  of  American 
Physicians,  1909.  Studies  made  at  the  Garfield  Memorial  Hospital,  Washing- 
ton, D.  C. 


THE    OXYGEN   BATH  323 

allow  final  conclusions  to  be  drawn,  but  the  uniformity  of  the 
results  obtained  speaks  for  the  correctness  of  the  findings. 
Whether  the  therapeutic  indications  for  the  use  of  cold  and  warm 
baths  will  be  modified  by  the  discovery  of  these  changes  in  the 
dimensions  of  the  heart  with  the  different  temperatures  of  the 
water  remains  to  be  seen. 

Rudolf  and  Beck  measured  the  heart  immediately  before 
entering  the  bath  and  again  directly  afterward.  It  was  uni- 
formly found  that  after  a  hot  bath  the  size  of  the  heart  was 
considerably  diminished,  and,  with  this,  a  marked  increase  in 
the  pulse  rate;  after  a  cold  bath  the  size  of  the  heart  increased, 
the  skin  became  pale,  and  there  was  a  diminished  pulse  rate. 
Rudolf  and  Beck  found  that,  in  the  case  of  Nauheim  baths, 
natural  or  artificial,  even  in  water  with  a  temperature  of  87°  to 
95°  F.  (30.6°-35°  C),  orthodiagrams  show  a  marked  diminu- 
tion in  the  size  of  the  heart,  \yithin  this  temperature  range, 
then,  it  would  appear  that  the  heart  responds  as  in  the  case  of 
hot  baths.  This  would  confirm  the  statement  of  Leslie  Thome, 
that  in  many  cases  a  good  reaction  cannot  be  obtained  if  the 
temperature  of  the  bath  be  below  96°  F.  (35.6°  C).  If  this  be 
found  to  be  the  case  in  any  given  instance,  it  would  be  unwise 
to  give  the  baths  at  any  lower  temperature.     (See  pp.  140-146.) 

THE  OXYGEN  BATH 

This  bath  depends  on  the  chemical  generation  and  diffusion 
of  oxygen  gas  in  water.  It  is  one  of  the  newest  features  of 
hydrotherapy,  having  been  introduced  only  as  late  as  1904  by 
Sarason.  He  used  hydrogen  peroxid  at  first  and  then  devised 
the  method  of  first  dissolving  about  300  gm.  of  sodium  perborate 
in  the  tub,  adding  then  15  gm.  of  manganese  borate.  This  latter 
acts  the  part  of  a  catalyzer  and  causes  the  sodium  perborate  to 
part  with  oxygen.  Various  modifications  of  the  oxygen  bath 
have  been  placed  on  the  market  in  Germany.  Sarason  adopted 
the  name  "  Ozet  bath  ";  Wolfstein  called  his  "  Brozon  ";  Kopp 
and  Joseph  gave  theirs  the  name  '^  Zeozon."  Sarason's  bath  has 
been  introduced  to  the  American  market  as  the  "  Perogen  bath," 
the  exact  nature  of  its  constituents  are  not  yet  made  public,  as 


324  HYDROTHERAPY 

patents  arc  pending.  The  proprietors,  Morgenstern  ami  Co., 
of  New  York,  state  that  they  will  i)ublish  the  nature  of  the 
catalyzer  when  a  patent  is  issued.  The  ''  Ozet "  bath  is  patented 
in  all  I'^uropcan  countries.  These  baths  are,  in  a  measure, 
analogous  to  carbonic  acid  baths,  in  that  minute  bubbles  of  gas 
are  generated  and  attach  themselves  to  the  bather's  skin,  pro- 
ducing a  sense  of  exhilaration  which  is  succeeded  by  a  sedative 
action  rendering  it  of  considerable  therapcnitic  value.  The  only 
description  of  the  bath  that  we  have  met  with  in  English  is  by 
Dr.  Fredrich  Grosse,'  but  several  papers  have  been  i)ublished 
recently  in  Germany.  Among  these  are  j)apers  by  Frankl, 
Tornai,  and  Sommer. 

Dr.  Grosse's  description  of  th(>  oxygen  bath  is  as  follows: 
"  The  two  salts  arc  sold  in  the  market  in  separate  bags,  packed 
in  tins,  and  keep  well  for  any  length  of  time.  The  label  gives 
the  necessary  tk'tails  as  to  the  technic  of  the  procedure, 
which  yields  about  35  pints  of  nascent  oxygen.  The  oxygen 
bath  is  usually  given  as  a  full  bath  (reaching  uj)  to  the  jugular 
fossa),  but  other  forms,  such  as  hip-baths,  are  also  recom- 
mended. The  patient  lies  therein  without  any  unnecessary 
movement,  and  friction  or  soaping  is  to  be  avoided.  As  a  rule, 
plain  water  is  used,  but  there  is  no  objection  to  the  addition 
of  other  ingredients. 

The  temperature  of  the  water  is  usually,  according  to  the 
writers,  93°  to  89.5°  F.  (33.8°-31.9°  C.) ;  some  of  them  administer 
it  as  warm  as  98°  F.  (36.6°  C);  Laqueur'  considers  lower 
degrees  objectionable,  as  he  thinks  patients  would  feel  chilly, 
the  oxygen  not  being  so  powerful  in  warranting  the  sensation  of 
warmth  as  the  carbonic  acid.  I  find,  however,  at  least  in  some 
cases,  tliat  the  baths  also  of  88°  to  86°  F.  (31.1°-30°  C),  tem- 
peratures which  are  mentioned  also  by  Winternitz,  are  tolerated 
with  the  same  good  effects. 

"  The  duration  of  the  bath  is,  as  the  first  observers  state, 
fifteen  to  twenty  mintues ;  however,  I  see  no  contraindication  to 
prolong  it,  in  appropriate  cases,  up  to  thirty  minutes.     Even 

iThe  Post-Graduate,  September,  1909. 


THE    OXYGEN   BATH  325 

then  enough  oxygen  is  left  to  cover  the  bather's  skin,  especially 
if,  by  stirring  up  the  lower  strata  of  the  water,  the  last  traces 
of  the  chemicals  are  pushed  into  action. 

"  The  number  of  baths  given  as  regular  treatment  of  chronic 
cases  should  be,  according  to  Tornai,^  from  fifteen  to  twenty, 
and  according  to  Sommer,^  from  twenty  to  thirty.  The  litera- 
ture on  the  subject  is  yet,  of  course,  scanty,  but  all  writers  advise 
taking  one  bath  either  on  each  of  five  consecutive  days,  with 
four  or  five  free  days,  or  every  second  day.  In  hydrotherapeutic 
practice  waterless  days  are  frequently  introduced  during  the 
course  of  a  'cure.'  In  short,  I  hold  it  advisable  not  to  give 
routine  prescriptions,  but  rather  to  be  guided  by  the  needs  of 
the  case.  Again,  as  to  the  hour  of  bathing,  it  is  best  to  take 
into  consideration  all  the  numerous  trifles  of  the  sufferer  and 
his  surroundings,  with  the  only  exception  that,  to  bring  on  sleep, 
the  bath  should  be  taken  from  thirty  minutes  to  one  hour  before 
retiring,  and  even  here  we  have  to  consider  that  sometimes  we 
meet  a  case  who  experiences,  even  after  the  most  sedative  appli- 
cation, a  transient  period  of  excitation  before  sleep  occurs. 

"  As  the  oxygen  bath  is,  altogether,  a  rather  calmative,  rest- 
producing,  and  yet  indirectly  stimulating — the  German  ex- 
pression 'schonend'  includes  not  only  these  adjectives  but 
also  our  epithet  protective — application,  it  is  self-evident  that 
before  the  bath  the  patient  should  not  have  gone  through  any 
exciting  movements  of  any  nature,  such  as  walking,  for  instance ; 
and  after  it  also  he  should  rest  one  or  two  hours.  It  may  also 
be  useful  to  mention  that  he  ought  to  be  uniformly  warm; 
under  no  circumstances  should  he  enter  the  tub  with  cold  feet, 
because  the  procedure  is  by  no  means  one  accumulative  of  heat. 

"  As  the  temperature  of  the  oxygen  bath  is  usually  a  few  de- 
grees lower  than  that  of  the  skin,  the  bather  may,  at  the  first 
impact  of  the  water,  or  even  as  long  as  one  minute,  reahze  a 
chi  ly  feeling;  but  after  a  minute  or  so  this  is  changed  into  an 
agreeable  sensation  of  warmth,  '  as  if  the  water  had,  all  of  a 
sudden,  become  warmer.'  This  feeling  stays  as  long  as  the  bath 
lasts,  so  that  the  patients  often   remark    Hhey  wished  they 


326  HYDROTHERAPY 

coukl  remain  in  it  for  hours'  (Tournai).  Ay  soon  as  the  bather 
lies  quiet,  his  skin  is  (juickly  covered  by  a  glistening  layer  of 
finest  oxygen  bubbles,  which  become  closer  every  minute. 
Forming,  driving  up,  bumping  against  the  skin  and  its  lanugo, 
they  cause  a  queer  tickling  and  prickling  sensation  that  is  very 
agreeable.  A  discoloration  is  caused  by  the  formation  of  man- 
ganese oxid  from  the  catalyser  and  consists  of  a  very  fine,  soft, 
slimy  mud  that  covers  bather  and  tub;  though  it  is  very  easily 
rinsed  away  by  water  without  leaving  any  lasting  stain  what- 
ever, it  is  by  no  means  recommendatory  of  the  ozet  bath.  In 
contradistinction,  the  perogen  bath  leaves  merely  a  very  fine 
yellowish  hue  scarcely  visible  on  a  wet  towel. 

"  According  to  modern  osniology,  the  skin  is  always  covered 
with  a  layer  of  air,  the  molecules  of  which  adhere  relatively 
closel)^  to  the  body  surface,  so  that  one  might  roughly  speak 
of  an  involucrum  or  tegument  of  condensed  air.  This  resists 
decidedly  even  mechanical  removal,  so  that  Zickel,*  a  pioneer 
osmologist,  advocates,  in  order  to  facilitate  and  increase  the 
eff"ect  of  tub  baths,  rubbing  of  the  skin  with  alcohol  and  applica- 
tion of  thorough  wet  and  dry  friction  before  such  a  hydro- 
therapeutic  procedure  is  undertaken.  As  to  the  oxygen  bath, 
the  procedure  may  be  thus :  after  the  perborate  has  been  added, 
the  patient,  having  previously  been  rubbed  with  alcohol,  enters 
the  tub  and  undergoes  gentle  but  thorough  friction  all  over,  under 
water.     Then  the  catalyser  is  added. 

"In  the  oxygen  b^th  the  layer  of  oxygen  is  substituted  for 
the  air  involucrum  and  so  increased  that  it  becomes,  as  it  were, 
visible.  The  point  of  indifference  of  water  is  93°  to  99°  F. 
(33.8°-37.2°  C).  This  is  much  higher  than  that  of  air,  i.  e.,  68° 
to  77°  F.  (20°-25°  C),  and  the  indifference  point  of  0,  is 
decidedly  lower  yet.  Furthermore,  as  gas  is  a  bad  conductor  of 
warmth,  the  terminals  of  the  thermic  nerves  are  surrounded 
by  a  medium  perceptibly  warmer  than  the  water.  All  this 
combines  to  bring  about  a  sensation  of  warmth  that  is  conveyed 
to  the  central  stations,  and  the  bather  feels  the  water  warmer 
than  it  really  is.     Besides  this  action  on  the  thermic  nerves. 


THE    OXYGEN   BATH  327 

other  stimuli  act  upon  the  nervous  elements  within  the  skin, 
regulating  the  peripheral  circulation.  Whether  these  are  of 
physical  or  of  chemical  nature,  or  both,  is  difficult  to  decide, 
but  there  is  no  doubt  that  a  pronounced  contraction  of  the 
cutaneous  vessels  takes  place,  causing  a  distinct  paleness. 
Entirely  otherwise  than  in  the  carbon-dioxid  bath  and  other 
water  applications,  this  vessel  contraction  and  consequent 
peripheral  anemia  is  not  accompanied  by  chills  or  goose-skin. 
Perhaps  the  central  nervous  stations,  because  of  the  aforesaid 
impression,  fail  to  institute  the  contraction  of  the  cutaneous 
muscular  elements;  perhaps,  also,  we  have  there  a  specific 
stimulus  for  the  skin  heart  of  Hutchinson. 

''  As  to  the  pulse,  the  rate  is,  as  all  observers  report,  reduced  in 
proportion  to  what  it  was  before  the  bath,  and  at  the  same  time 
irregularity  and  weakness  are  markedly  corrected;  indeed,  in 
this  line  the  oxygen  bath  has  the  very  same  favorable  influence 
as  the  carbon-dioxid  tubs.  The  respiration  is  acted  upon  in  a 
similarly  sedative  way;  the  inner  temperature  remains  un- 
changed. The  experimenters  do  not  fully  agree  as  to  blood- 
pressure.  We  know  that  baths  below  the  indifference  point  are 
liable  to  increase  it ;  those  of  an  indifferent  temperature  to  leave 
it  unchanged,  and  baths  warmer  than  this  lower  the  pressure. 
Temperature  seems  to  have  more  effect  upon  it  than  any  other 
factor.  According  to  this  the  figures  of  Ekgren,^  Winternitz,® 
Laqueur,  Schnuetgen,^  Tornai,  Mueller,^  and  Scholz^  point 
mostly  to  a  reduction;  only  Ekgren  observed  an  increase  after 
91°  F.  (32.7°  C).  Altogether,  the  tabulated  figures  are  mostly 
relatively  small,  in  normal  cases  hardly  over  or  under  naught. 
Immediately  after  the  beginning  of  the  bath  a  transient  increase 
may  be  noticed,  and,  again,  well  observed  cases  show  lowered 
figures  even  for  hours  afterward.  Experiments  concerning  me- 
tabolism are  yet  entirely  lacking.  However  all  this  may  turn 
out,  I  hold,  with  Frankl,^''  that  all  these  trials  are  of  relatively 
little  importance,  as  the  changes  caused  by  and  following  the 
bath  are  altogether  minimal.  Only  this  can  be  taken  as  sure, 
that  the  oxygen  bath  reduces  abnormal  augmentation  of  hlood- 


328  HYDROTHERAPY 

pressure,  rate  of  pulse,  aiid  respiration,  while  the  healthy  are  not 
more  affected  than  by  a  corresponding  plain  water  bath  of  like 
temperature  and  duration.  As  the  skin  certainly .  does  not 
contain  more  blood,  this  must  be  directed  more  toward  other 
areas.  And  as  there  are  no  phenomena  whatever  that  might 
point  to  congestions  of  inner  organs,  ^^'internitz's  suggestion 
that  the  blood  is  chiefly  turned  toward  the  skeleton  muscles 
seems  to  be  acceptable.  Howe\'er  this  may  be,  the  oxygen 
bath  acts  just  contrary  to  the  carbon-dioxid  tub,  which  drives 
the  blood  toward  the  skin,  powerfully  depleting  the  inner 
organs. 

"  Winternitz  holds  that  the  prickling  sensation  in  the  water 
is  attributable  to  clonic  contractions,  and  is  identical  with  the 
pulsation  of  the  skin  heart. 

"  In  his  first  publication  Sarason  suggested  that  oxygen  might 
be  present  as  ozone,  but  according  to  Schnuctgen  all  ozone  tests 
were  negative. 

"  It  may  be  plausible  to  assume  that  the  oxygen  is  of  im- 
portance, the  more  so  as  it  seems  to  be  present  in  its  nascent 
form.  As  to  this  we  see,  indeed,  favorable  effects  wherever 
an  increased  respiratory  intake,  independent  of  a  bath,  is  known 
as  being  of  benefit;  here  asthma  and  cyanosis  and  difficult 
breathing,  incidental  to  pulmonary  congestion,  may  be  men- 
tioned (Naumann  ").  Now  and  then  we  find  a  patient  who, 
after  entering  a  full  bath,  feels  oppressed ;  such  cases  stand  the 
tub  better  in  its  oxygen  form. 

"  An  appreciable  absorption  of  oxygen  through  the  skin  is 
inadmissable  (A^internitz).  Zuelzer,  Salomon,  and  Schierbeck 
found  that  the  perspiring  and  hyperemic  skin  may  absorb  up 
to  4  or  5  per  cent,  of  the  pulmonary  intake,  but  in  the  O^  bath 
the  skin  is  not  hyperemic,  and  even  if  the  amount  were  larger, 
we  know,  from  the  experiments  of  Speck,  Lowy,  and  Durig, 
that  increased  ingestion  of  oxygen  does  not  favor  metabolism.'^ 
Still,  according  to  v.  Koranyi  (Michaelis,  Handbuch  dcr  Sauer- 
stofftherapie,  1906),  it  may  decrease  the  viscosity  of  the  blood 
and  thus  facilitate  metabolism  and  catabolism. 


THE   OXYGEN  BATH  329 

"  Oxygen  being  one  of  the  most  powerful  disinfectants,  it  is 
obvious  that  we  may  expect  results  due  to  this  effect. 

"  Independently  of  the  chemic  part  of  the  oxygen,  we  have 
to  consider  the  physical  effects  of  the  gas  bubbles. 

"  The  minute  oxygen  bubbles,  forming  and  bumping  against 
the  nerve  terminals,  running  into  one  another,  driving  up  and 
striking  along  the  lanugo,  acting  like  a  gas  brush,  as  Sarason 
aptly  pictured  the  process,  exert  uniform,  mild,  and  constant 
stimulation  upon  the  nervous  endings,  resembling  in  action  a 
sublime  massage.  All  stimuli  of  the  outer  world  being  ex- 
cluded, the  effect  of  this  ideal  overexertion,  conveyed  toward 
the  nervous  centers,  institutes  a  sedative  action,  almost  ike  the 
continuous  bath,^  the  sovereign  calmative  effect  of  which  is  gen- 
erally recognized.  In  conformity  with  this,  we  see  that  all 
writers  on  the  subject  lay  stress  upon  its  sedative  character  in  the 
manifold  paresthesias  of  neurasthenic,  hysteric,  and  tabetic 
origin  and  its  decided  and  reliable  soporific  action.  At  the  same 
time  it  has  a  soothing  and  indirectly  stimulating  influence,  as 
is  evident  in  asthma  and  other  respiratory  difficulties,  and  in 
its  distinct  corrective  action  upon  pulse  irregularities  of  all 
kinds,  and  thus  it,  doubtlessh^,  resembles  the  carbonic  acid 
bath,  the  outbalanced  pulse  becoming  stronger,  slower,  and 
regular. 

"  In  conclusion,  we  may  outline  the  physiologic  action  of  the 
oxygen  bath  thus:  (1)  It  is  a  neutral  bath  that  (2)  acts  oxidiz- 
ingly  and  disinfectingly  upon  the  skin;  (3)  it  has  a  powerfully 
suggestive  influence,  and  (4)  alters  innervation  by  discontinuation 
of  paresthesias,  by  its  sleep-promoting  peculiarity,  and  by  its 
generally  sedative  and  indirectly  stimulating  action;  (5)  it  is 
a  circulatory  revulsive,  most  probably  turning  the  blood  from 
the  skin  toward  the  inner  body,  especially  into  the  muscular 
areas,  and  (6)  it  reduces  an  abnormally  increased  blood-pressure, 
at  the  same  time  probably  rendering  the  blood  less  viscid. 

''  Though  the  literature  on  oxygen  gas  baths  is  not  voluminous 
and  many  points  may  be  still  disputable,  further  experimenta- 
1  ContinuQus  Bath,  by  Grosse,  Med.  Brief,  1905,  viii. 


330  HYDROTHERAPY 

tion  will  liardly  bring  forward  new  facts  of  greater  importance. 
►Setting  aside  the  cutaneous  anemia,  with  its  pecuHar  lack  of 
goose  skin  and  chilliness,  the  oxygen  hath  i)resents  no  feature 
essentially  different  from  other  well-studied  hydrotlun-apeutic 
phenomena,  so  that,  according  to  the  physiologic  arguments 
by  which  we  have  tried  to  analyze  the  difTerent  components, 
we  may  state  the  clinical  indication  as  follows : 

"The  perogen  bath  may  be  given  whenever  a  nc^utral  or  in- 
different one  is  indicated,  which  means  a  full  l)ath  of  such  tem- 
perature and  duration  as  do  not  change  materially  the  body's 
inner  warmth,  that  is,  of  93°  to  98.0°  F.  (33.8°-37°  C),  and 
of  fifteen  to  thirty  minutes;  and  when  we  shorten  the  duration 
down  to  ten  minutes  we  may  call  a  temperature  neutral,  even  as 
far  as  90°  F.  (32.2°C.)  and  even  88°  F.  (31.1°  C). 

"  The  gas  bath  is  preferable  also  when  we  want  to  impress  a 
case  with  potent  suggestions.  The  perogen  bath,  with  its 
different  ingredients,  which  are  to  be  carefully  distributed  and 
dissolved;  with  its  sequent  milky  turbidity;  with  its  mystic 
sizzling;  with  the  queer  formation  of  the  gaseous  tegument, 
fascinating  both  eyes  and  sensibility;  with  the  gradual  darken- 
ing of  the  water  and  its  muddy  sediment  upon  the  skin;  with 
the  puzzling  sensation,  as  if  the  water  suddenly  had  turned 
warmer,  and  last,  but  not  least,  with  blissfully  free  respiration, 
has  a  valuable  multitude  of  suggestive  features.  Not  only  will 
the  horde  of  hysterics  fall  in,  but  also  many  of  the  blase  com- 
plainants of  the  wealthy  classes,  and  many  half-read  persons, 
who  believe  they  know  and  understand  everything,  will  thus 
be  induced  to  bathe  regularly  and  in  accordance  with  our  pro- 
gi'am — details  apparently  of  little  importance  and  yet  sometimes 
extraordinarily  valuable. 

"  It  would  further  be  of  interest  and  importance,  if  the  disin- 
fectant power  upon  germs  within  the  epidermis  and  its  gland 
ducts  were  examined  in  the  wards  for  contagious  diseases,  as 
in  scarlatina,  measles,  small-pox;  or  for  microbic  skin  diseases, 
as  psoriasis,  favus,  impetigo,  certain  forms  of  eczema,  and  others. 


THE    OXYGEN    BATH  331 

This  may  be  of  the  utmost  value  for  the  prevention  of  many 
epidemics. 

"  Paresthesias  located  in  the  body  surface  are  the  next  indica- 
tion. So  far,  the  reports  seem  to  deal  chiefly  with  nervous 
forms,  though  those  chemically  caused,  such  as  the  most  trouble- 
some itching  occurring  sometimes  in  liver  diseases,  are,  most 
probably,  not  out  of  question.  As  another  group  of  parasthesias 
is  apparently  characterized  by  superficial  hyperemia,  as,  for 
instance,  'burning  hands  and  feet'  and  local  hyperhidroses, 
I  tried  local  0^  baths  in  one  case  of  burning  feet  of  apparently 
vasomotor  origin,  with  strikingly  good  effect.  Though  one  case 
allows  of  no  inference,  it  is  certainly  suggestive  to  think  of  it 
in  similar  cases,  the  more  so  as  the  treatment  of  this  form  of 
a,nomalies  is  a  crux  alike  for  the  physician  and  the  patient. 
In  regard  to  these  and  antisepsis,  again  the  suggestions  of  our 
osmologists  may  be  noteworthy,  as  when  their  advice  is  followed 
the  oxidizing  effect  must  be  multiplied. 

"  As  we  have  seen,  the  perogen  bath  is,  furthermore,  of  a  de- 
cidedly sedative  character,  combining  with  this  quaUty,  in 
contradistinction  to  drugs,  positively  a  welcome  stimulation. 
It  seems  to  me  that  this  is  of  an  importance  that  can  hardly  be 
overestimated  in  conditions  of  excitation,  such  as  is  so  often 
met  with  in  persons  of  rather  too  liable  a  nervous  system,  who 
are  thrown  out  of  balance  by  every  little  happening  of  every- 
day character.  For  here,  again,  the  bodily  effect  is  enhanced 
by  suggestion. 

"  Finally,  here  may  be  added  the  fact  that  Franks"  advocates 
the  oxygen  bath  in  a  special  article  on  cUmacteric  molimina; 
'for  the  ambulant  treatment  of  which  the  O2  baths,  as  they 
have  been  studied  by  other  experimenters,  seem  to  have  been 
predestined.'  Of  course,  anatomic  alterations  of  the  pelvic 
organs,  some  sufficiently  well-known  hemorrhages,  and  climacteric 
obesity  are  out  of  the  question  here.  It  is  the  very  same  line 
of  vasomotor  and  nervous  disturbances,  mostly  presenting  an 
increased  blood-pressure,  from  which  likewise  Diihrssen,  Engel- 
mann,  and  others  recommend  a  general  hydro-  or  balneothera- 


332  HYDROTHERAPY 

poutic  procedure  in.  <];en('ral,  and  Gottschalk,  Baelz,  Grosse," 
and  others,  above  other  applications,  the  hot  (107°  F.  — 41.G°C.) 
full  bath  for  six  to  eight  minutes.  In  all  these  means  the  reduc- 
tion of  blood-j^ressure  is  the  effect  wanted,  but  even  here  the 
suggestive  influence  should  never  be  excluded. 

"  This  gives  me  occasion  to  mention  the  only  contraindica- 
tion concerning  oxygen  baths;  namely,  conditions  of  low  blood- 
pressure,  no  matter  of  what  origin.  It  may  also  be  of  value  to 
direct  attention  to  the  fact  that  in  rare  cases  an  idiosyncrasy  for 
oxygen  has  been  found.  Thus  in  one  patient  vomiting  occurred, 
and  in  a  woman,  forty-six  years  of  age,  suffering  from  endo- 
carditis and  mitral  insufficiency,  violent  heart  palpitation  has 
been  reported. 

"  To  sum  up:  Winternitz,  the  father  of  hydrotherapy,  is  right 
in  stating  that  the  oxygen  bath  forms  a  new  link  in  the  chain 
of  procedures  adapted  to  domesticate  hydrotherapy.  It  is 
welcome  as  a  substitute  for  other  hydriatric  applications,  valua- 
ble as  to  innervation  and  Oj  ingestion,  and,  above  all,  entirely 
new  and  without  parallel  as  a  peculiar  circulatory  revulsive." 

References. 

1.  Deutsch.  Med.  Wochenschr.,  1904,  No.  45. 

2.  Zeitschr.  f.  phys.  u.  diiit.  Ther.,  xii,  p.  424. 

3.  Zeitschr.  f.  neuere  phys.  Med.,  1908,  No.  18. 

4.  Neuere  Fortschritte  d.  Klin,  osmologischen  Heilkunde,  Berlin,  1905. 

5.  Zeitschr.  f.  Klin.  Med.,  Bed.  57. 

6.  Blaett.  f.  Klin.  Hydrother.,  1907,  p.  1. 

7.  Ther.  d.  Gegenwart,  April,  1907. 

8.  Munch,  med.  Wochcn.sclir.,  1908,  No.  .30. 

9.  Deutsch.  med.  Wochenschr,  29  July,  1909. 

10.  Zeitschr.  f.  phys.  u.  diiit.  Ther.,  Bd.  xii,  p.  291. 

11.  Ther.  d.  Gegenwart,  1908,  .3. 

12.  Low-y  und  Zulz,  Die  physiolog.  Grundlagen  der  Sauerstoffther. 

13.  The  Hot  FuU  Bath,  Med.  Rec,  1904,  p.  326. 

MUD  BATHS  AND  FANGO  PACKS 

These  are  applied  for  rheumatism,  gout,  arthritis  deformans, 
and  the  neuralgias.  They  act  principally  through  the  heat 
applied,  and  are,  of  course,  not  dependent  on  absorption  of  the 


MUD  BATHS  AND  FANGO  PACKS  333 

minerals  contained  in  the  bath,  although  no  doubt  the  skin  is 
favorably  affected  by  the  sahne  and  alkahne  substances  employed. 

Mud  Baths. — For  these  baths  the  patient  lies  in  a  tub  contain- 
taining  the  prepared  mud  mixed  with  a  sahne  or  carbonated 
water.  The  most  famous  mud  baths  are  those  of  Carlsbad, 
Kissingen,  Baden  Baden,  Leipsic,  Vienna,  Weisbaden,  and  Sal- 
somaggiore  and  Battaglia,  Italy.     (See  also  p.  128  et  seq.) 

Fango  is  an  Itahan  volcanic  mud.  In  color  it  is  a  soft  grayish 
brown,  plastic,  and  of  about  the  consistency  of  butter  and  equally 
soft  to  the  touch.  It  has  no  odor  and  after  application  is 
quickly  and  completely  removed  by  a  warm  douche,  lea\'ing 
the  skin  absolutely  clean.  The  analysis  shows  that  it  is  com- 
posed of  11  per  cent,  of  combustible  and  volatile  matter  with 
carbonates  and  sulphates  and  sulphids  of  iron  and  hme,  and 
sulphates  of  potassium  and  sodium.  It  is  said  to  be  radio- 
active. 

The  fango  is  appUed  warm  hke  a  great  sterilized  poultice. 
It  conveys  heat  and  retains  it.  The  pack  may  be  appUed  first 
at  110°  F.  (43.3°  C.)  for  ten  minutes,  and  the  temperature  and 
duration  increased  in  successive  appHcations  up  to  125°  F.  (51.7° 
C.)  for  twenty,  tliirty,  and  forty  minutes.  Gentle  massage  may 
be  given  after  the  pack. 

Apphed  in  this  manner  to  a  joint  or  hmb  the  effects  are  of  the 
fango  bath:  stimulation  of  cutaneous  reflexes,  with  dilatation 
of  superficial  capillaries;  increased  activity  in  the  normal  pro- 
cesses of  absorption  of  morbid  deposits,  and  repair  of  damaged 
tissues.  Perspiration  is  promoted  and  there  is  a  slight  increase 
of  body  temperature,  2°  F.  (1.1°  C),  subsiding  rapidly  after 
the  removal  of  the  pack,  and  due  to  direct  conveyance  of  heat 
to  the  blood.  Dr.  Cecil  Sharpe,^  of  London,  has  recently  re- 
ported 13  cases  of  stiff  and  painful  joints  treated  in  this  manner. 

In  subacute  rheumatism,  lumbago,  rheumatoid  arthritis, 
neuritis,  sciatica,  sprains,  and  old  injuries  of  the  ankle,  fango 
gives  good  results.  Among  its  advantages  are  the  application 
only  to  the  part  involved,  and  the  fact  that  these  packs  are 

^  W.  Cecil  Sharpe,  M.  D.,  Jour.  Balneology  and  Climatology,  January,  1905. 


334 


HYDROTHERAPY 


given  in  various  cities  with  the  mud  inijjortcd  from  Battaglia 
where  the  fango  is  found  in  connection  with  hot  springs. 

This  treatment  can  be  obtained  in  BattagUa  and  Acqui,  in 
Italy;  at  the  Anstalt  for  Physiologic  Therapeutics,  University 
Clinic,  Munich;  at  London,  at  Smedley's,  Matlock,  England; 
at  Baden  Baden,  at  Kissingen,  Germany;  at  69  West  90th 
Street,  New  York  City,  and  at  Mudlavia,  near  Attica,  Indiana. 


MUD  AND  PEAT  BATHS 

These  are  employed  in  Europe,  especially  at  Franzensbad, 
Elster,  Marienbad,  Driburg,  Carlsbad,  and  Buxton,  England. 
The  mud  baths  (Schlammbiider)  consist  of  a  soft  mass  of  in- 


Fig.  105. — -Moor  baths,  Rnxton.      l^ipgiiiK  tho  jioat  in  winter. 

organic  mud  rich  in  silicious  matter.  The  peat  baths  (Moor- 
bader)  contain  both  organic  and  inorganic  matter,  and,  like  the 
mud  baths,  are  applied  as  immense  poultices,  either  locally  or 
generally  at  temperatures  ranging  from  118°  to  122°  F.  (47.7°-50° 
C).  These  mud  and  moor  baths  can  be  given  at  higher  tem- 
peratures because  the  medium  is  a  comparatively  poor  conductor 
of  heat.  In  local  applications  sand  baths  may  be  raised  in  spe- 
cial cases  as  high  as  133°  F.  (56.1°  C).     These  local  baths  may 


SAND   BATHS 


335 


also  be  continued  much  longer  than  full  baths  and  are  frequently 
as  much  as  an  hour  or  an  hour  and  a  half  long;  while  forty  to 
forty-five  minutes  suffices  for  the  full  bath  and  forty-five  to 
sixty  minutes  for  the  half-bath.  Friction  is  sometimes  used 
in  mud  and  peat  baths  and  the  innumerable  fine  hard  substances 
or  spicules,  the  remains  of  shells  or  plants,  act  as  a  stimulant  to 
the  skin. 

Peat  baths  are  used  in  chronic  pelvic  affections.    Their  action 
is  Hke  that  of  a  widespread  poultice.     They  are  useful  in  gout^ 


3!^ 


Fig.  106. — Moor  baths,  Buxton.      Bringing  in  the  peat  in  winter. 


rheumatism,    lumbago,    and    sciatica.     In    all    neuralgias    low 
temperatures,  113°  F.  (45°  C),  are  best. 

The  peat  baths  at  Marienbad  are  ferruginous,  and  those  at 
Driburg  sulphurous. 


SAND   BATHS 

These  are  naturally  not  hydrotherapeutic  measures,  but  are 
found  at  some  resorts  where  other  baths  are  given.  It  is  one 
means  of  raising  the  body  temperature  and  powerfully  exciting 
the  skin. 


336 


HYDROTHERAPY 

SITZ-   OR  HIP-BATH 


A  special  tub  is  retjuired  for  hip-baths,  so  that  the  patient 
may  sit  in  water  with  liis  thighs  resting  against  the  front  of  the 


Fig.  107.— Sitz-l. 

tub,  and  his  knees,  legs,  and  feet  i)rotectcd  by  a  blanket,  while 
the  latter  are  in  warm  water.     The  top  of  the  patient's  head  is 


Fig.  108. — Sitz-bath  tub  made  of  tin  (Ashton). 

covered  with  a  cold  wet  cloth  and  the  tub  is  partially  filled  with 
water.  The  temperature  of  the  water  can  be  raised  or  lowered 
as  required.     If  necessary  to  raise  the  temperature  above  104  °  F. 


SITZ-   OR   HIP-BATH 


337 


(40°  C.)  pitchers  of  hotter  water  can  be  added  cautiously;  if, 
on  the  other  hand,  it  is  necessary  to  lower  the  temperature,  cold 
water  can  be  added.  In  the  latter  case  quick  friction  of  the 
submerged  portions  is  required.  The  hot  bath  raises  the  pulse 
and  lowers  the  pressure,  the  reverse  being  the  case  when  cold 
water  is  used.  The  results  are  largely  due  to  reflex  excita- 
tion of  the  sympathetic  nervous  system.     The  hot  bath  diverts 


Fig.  109. — Sitz-bath  with  abdominal  friction  (Gant). 

blood  from  the  abdominal  organs,  while  cold  baths  produce 
congestion.  Hence,  in  all  atonic  states  of  the  bowels,  urinary 
and  generative  organs  cold  acts  a  a  stimulant  if  the  baths  be 
short  and  friction  be  apphed.  If  such  baths  be  prolonged,  the 
stimulant  effect  is  not  obtained. 

It  should  .be  "remembered  in  giving  the  sitz-bath  carefully  to 
cover  the  unimmersed  parts  of  the  body,  otherwise  the  effect 
may  be  entirely  annulled,  especially  in  intestinal  affections. 

In  menstrual  disorders  warm  and  hot  sitz-baths  are  often 

22 


338 


HYDROTHERAPY 


corrective.'  Brief  cold  liip- baths  are  useful  in  vesical  and 
intestinal  paralysis,  in  debilitated  states  of  the  male  sexual 
organs,  in  prolapsus  ani,  and  in  intestinal  atony. 

Prolonged  cold  hijvbaths  are  advocated  by  Misiewitz  in 
hemorrhagic  states  of  the  urethra,  bladder,  intestines,  and 
uterus;  in  hemorrhoids  and  in  perimetritis. 


Fig.  110. — "Lisbon"  seat  bath  (J.  L.  Mott  Iron  Works). 

Counterindications. — These  baths  are  counterindicated  in 
hyperemic  states  or  congestions  of  the  pelvic  organs;  in  sexual 
or  vesical  irritability,  in  seminal  emissions,  in  tenesmus,  in 
menorrhagia,  in  uterine  coUc,  in  acute  cystitis,  and  in  intense 
tenesmus. 


PACKS-COLD  WET  PACKS  (FEUCHTE  EINPACKUNG). 
HOT  WET  PACKS.  DRY  PACKS  (TROCKENE  EIN- 
PACKUNG) 

Packs  were  first  used,  as  far  as  kno\\Ti,  by  Lucas,  an  English 
physician,  who  lived  about  the  middle  of  the  eighteenth  century. 

*  See  page  226.  For  a  full  discussion  of  hydrotherapy  in  diseases  of  women, 
see  Ashton's  Practice  of  Gynecology,  4th  ed.,  1909;  also  Bandler's  Medical 
Gynecology,  2d  ed.,  1909. 


COLD    WET,    HOT   WET,    AND    DRY   PACKS  339 

Later,  about  1835,  they  were  rediscovered  and  used  by  Vinzenz 
Priessnitz,  of  Grafenberg. 

These  procedures,  apparently  so  dissimilar,  are  very  closely 
related,  not  only  in  their  visible  form  but  also  in  their  physiologic 
effect.  An  aphorism  of  Hippocrates  was  that  cold  produces 
heat,  and  this  simple  statement  comprises  one  of  the  greatest 
and  most  fundamental  truths  in  physiologic  therapeutics.  It 
was  a  remarkable  mind  that  was  able  to  grasp  and  to  express 
over  two  thousand  years  ago  what  even  now  seems  so  paradoxic. 

One  of  these  curious  paradoxes  in  the  practice  of  hydrotherapy 
is  the  fact  that  after  the  removal  of  the  cold  wet  pack  the  damp 
sheet  is  found  warm ;  while  after  the  removal  of  the  hot  blanket 
pack,  as,  for  example,  in  cases  of  chronic  nephritis  or  the 
nephritis  of  pregnancy,  the  damp  blankets  are  sometimes  found 
to  be  cool.     (See  p.  118.) 

Bed  or  Table  for  Applying  Packs. — In  applying  a  pack  it  is 
convenient  to  have  a  narrow  bed  or  table  of  substantial  con- 
struction, such  as  that  shown  on  pages  235  and  236.  This  bed 
or  table  may  be  of  iron  tubing  with  a  strong  spring  to  support 
the  mattress;  or  it  may  be  of  wood  with  stout  legs  and  a  plain 
top  and  not  intended  for  a  mattress,  but  for  blankets  and  sheets. 
This  is  the  type  of  table  used  for  massage  and  commonly  for 
packs  and  alcohol  rubbing.  For  packs  of  long  duration  the 
narrow  iron  bed  with  springs  and  mattress  is  the  more  comfort- 
able for  the  patient.  A  high  table  is  convenient  for  the  operator, 
but  a  low  bed  is  safer  for  the  patient  should  he  belong  to  that 
class  of  mental  or  refractory  patients  for  which  such  measures 
are  much  employed. 

The  bed  and  mattress  are  protected  with  a  rubber  sheet, 
and  on  this  a  large  blanket  is  spread  long  enough  to  reach  from 
the  nape  of  the  neck  to  beyond  the  foot  of  the  bed,  and  wide 
enough  to  hang  over  the  side.  A  hair  pillow,  covered  with  white 
rubber  cloth,  and  a  pillow  sKp  is  placed  at  the  head. 


340  HYDROTHERAPY 

COLD   WET  PACK 

Requisites. — The  bctl  or  table  prepared  as  above.  One  or 
two  acklitional  blankets;  a  linen  or  cotton  sheet;  4  small  towels, 
and  a  hot-water  bag.  The  bag  is  half-filled  with  hot  water, 
not  over  120°  F.  (48.9°  C).  A  foot-bath  is  required  with  water 
at  102°  to  105°  F.  (3S.9°-40.6°  C).  A  pitcher  of  ice-water, 
a  bucket  of  water  for  the  sheet  at  65°  or  70°  F.  (18.3°  or  21.1  °  C), 
or  at  the  required  temperature. 

Technic. — The  jmtient  in  wrapper  sits  in  a  convenient  chair 
with  feet  in  the  bath  of  warm  water  and  with  a  cold  compress 
on  the  head.  The  attendant  then  wrings  out  the  sheet  from 
the  water  in  the  bucket  and  spreads  it  smoothly  over  the  bed, 
so  as  to  reach  near  the  foot.  The  patient  then  quickly  drops 
all  clothing  and  lies  on  the  wet  sheet  with  the  arms  extended. 
The  attendant,  standing  on  the  right  sitle,  promptly  draws  the 
overhanging  left  side  of  the  sheet  across  the  body,  smoothing 
it  between  the  lower  limbs  and  along  the  right  side.  The  arms 
are  then  lowered  to  the  sides  and  the  remaining  free  portion  of 
the  sheet  is  drawn  over  the  body  and  smoothly  adjusted  over 
the  lower  limbs,  covering  in  both  arms.  The  feet  are  left  un- 
covered by  the  sheet,  but  the  hot-water  bag,  covered  with  a 
towel,  is  placed  at  the  soles.  The  underlying  blanket  is  adjusted 
in  a  manner  similar  to  the  sheet,  except  that  it  is  not  tucked 
between  the  lower  limbs,  and  the  surplus  at  the  feet  is  folded 
under  them.  The  blanket  should  be  closely  adjusted  at  the  neck 
so  as  to  exclude  all  air.  Another  blanket,  folded  in  several 
thicknesses,  is  then  placed  over  the  entire  body  from  the  neck 
down  and  tucked  snugly  in  at  the  sides.  A  fresh  turban  of  ice- 
water  is  adjusted,  to  be  changed  every  five  minutes  as  it  warms. 

It  is  found  in  many  cases  that  if  the  wet  sheet  is  allowed 
to  extend  beyond  the  feet  and  is  then  placed  over  the  feet  with- 
out the  use  of  the  hot-water  bag,  the  reaction  in  the  feet  is  slow 
and  correspondingly  unsatisfactory.  There  is  no  advantage  in 
covering  in  the  feet  with  the  cold  wet  sheet,  and  the  use  of  the 
hot-water  bag  favors  the  action  of  the  pack. 


THE  HOT  WET  PACK 
THE  HOT  WET  PACK 


341 


This  is  applied  in  tliree  principal  ways:  viz.,  by  means  of  a 
sheet  wrung  out  of  hot  water;  by  means  of  a  blanket  wrung 
out  of  hot  water;  and  by  means  of  both.  In  many  cases,  espe- 
cially in  treating  children,  the  first  method  suffices,  and  it  avoids 
the  necessity  of  deahng  with  wet  blankets. 


Fig.  111. — Adjusting  the  first  half  of  sheet. 

Requisites. — These  are  the  same  as  for  the  cold  wet  pack, 
excepting  that  a  bucket  of  hot  water  should  be  provided.  The 
bed  is  protected  as  previously  described  and  on  it  two  blankets 
are  spread. 

Technic. — The  sheet,  having  been  wrung  out  of  the  hot  water, 
is  then  unfolded  and  laid  on  the  upper  blanket.     The  patient  is 


342 


HYDROTHERAPY 


then  placed  in  bed  quickly,  the  sheet  quickly  losing  sufficient 
heat  to  make  this  possible.  The  sheet  should  not  extend  beyond 
the  junction  of  the  head  and  neck. 

AVhile  the  patient's  arms  are  raised,  one  side  of  the  sheet  is 
quickly  drawn  across  and  tucked  under  the  opposite  side  and 
folded  between  the  lower  hmbs;   then  the  arms  are  lowered  in 


l"i'_'    II'-! — Patii-iit  ciivcIoixmI  ill  tlif  slieet. 

the  cold  pack,  and  the  remaining  side  of  the  sheet  is  carried 
across  and  smoothly  applied,  enclosing  both  arms  and  lower 
limbs.  The  hot- water  bottle,  suitably  guarded,  is  placed  at 
the  feet,  and  the  upper  blanket  is  then  adjusted  as  in  the  case 
of  the  cold  wet  pack.  After  that  the  under  blanket  and  the  free 
ends  of  the  coverings  are  folded  under  the  heels.  In  from 
twenty  to  forty  minutes  perspiration  forms  on  the  forehead  and 


THE   HOT   WET   PACK 


343 


the  body  temperature  will  be  found  from  1  to  2  degrees  higher 
than  at  the  start. 

After  a  tepid  or  cool  sponging  the  patient  is  dried  and  re- 
moved to  bed,  which  has  been  previously  warmed.  The  bed- 
clothing  should  be  fairly  light. 


Fig.  113.— Adjusting  the  first  half  of  first  blanket. 


Indications. — This  pack  has  innumerable  uses,  especially 
where  defective  metabolism  is  met  with.  It  is  well  suited  for  the 
young,  the  weak,  and  the  aged.  Dr.  Leonard  Williams,  of 
London,  has  advocated  it  strongly  in  anemia,  in  the  sequelae  of 
scarlet  fever,  and  in  the  slight  catarrhs  of  the  air-passages  in 
children.  For  the  convulsions  of  children  it  is  far  neater,  more 
agreeable,  and  quite  as  effective  as  the  hot  bath.  The  child  is 
kept  quiet  and  his  head  is  more  easily  kept  cool 


344  HYDROTHERAPY 

In  uremia  the  hot  wet  pack  is  also  useful.     (See  p.  117.) 


Fig.  114. — Patient  enveloped  in  first  blanket. 

Many  a  case  of  puerperal  convulsions  has  been  saved  by  this 
procedure. 

DRY  HOT  PACK 

The  dry  hot  blanket  pack  is  commonly  used  after  the  warm 
douche  and  warm  or  hot  baths  in  the  treatment  of  gout,  rheuma- 
tism, syphilis,  and  obesity. 

COMPRESSES 

Action  of  the  Compress. — When  inflammation  with  arterial 
Venous  congestion  occurs  in  a  given  part  there  is  a  corresponding 
compression  of  the  nerve  trunks  by  the  overfilled  blood-vessels. 


COMPRESSES      . 


345 


Fig.  115. — Hot  dry  pack,  Hot  Springs,  Virginia. 


Fig.  116. — Reapplying  the  wet  cold  turban  in  the  hot  dry  pact 


346  HYDROTHERAl'Y 

Spasin  of  the  nutrient  vessels,  by  which  the  nerve  filaments  are 
coniprcssetl,  has  also  been  supposed  to  account  for  the  pain. 
If  the  blood  may  be  diverted  to  the  surface  or  to  some  other 
part  by  the  use  of  compresses,  relief  will  be  afforded.  (See  pp. 
210  and  213.) 

Materials. — For  the  cold  compress  the  material  used  is 
linen,  which  is  then  covered  closely  by  several  thicknesses  of 
flannel  to  pnn'ent  outward  radiation.  For  the  moist  hot  com- 
presses well-soaked  flannel  is  used,  covered,  as  in  the  former 
case,  with  a  sufficient  layer  of  dry  flannel. 

COLD  COMPRESS 

The  good  effects  of  a  cold  compress  are  well  seen  in  the 
treatment  of  pneumonia.  (See  p.  100  et  seq.)  The  water  should 
be  at  50°  or  60°  F.  (12.8°  or  15.6°  C).  The  linen  compress, 
18  inches  wide,  partly  wrung  out,  is  laid  smoothly  over  the 
affected  side,  extending  slightly  beyond  the  median  line,  front 
and  back,  and  is  then  covered  with  a  flannel  binder,  applied 
somewhat  loosely.  The  compress  should  be  changed  night  and 
day  every  hour,  and  it  is  i)Ossible  to  do  this  without  much  dis- 
turbance to  the  patient. 

Indications. — ^The  danger  in  cases  of  pneumonia  lies  in  the 
possibility  of  intoxication,  but  as  a  general  thing  this  is  not  so 
great  as  in  typhoid;  full  baths  are,  therefore,  not  desirable. 
The  failure  in  peripheral  circulation  causes  hypertension  of  the 
heart,  the  blood  being  driven  to  the  inner  ])arts,  and  it  is  just 
here  that  the  compress  gives  timely  assistance.  The  cold 
stimulates  the  heart,  and  with  the  systole  blood  is  driven  into 
the  peripheral  vessels.  The  central  nervous  system  is  also 
invigorated  by  the  effect  of  cold  on  the  capillaries  through  the 
muscle-fibers  of  the  skin.  As  the  skin  reacts  and  the  periph- 
eral circulation  improves,  the  heart  beats  slower  and  stronger 
and  the  increased  force  and  tension  of  the  pulse  are  shown  in 
the  kidney;  the  urine  excretion  is  also  increased.  The  crisis  is 
hastened  and  is  marked  by  a  drop  in  the  temperature  and  a  not- 
able improvement  in  the  rate  and  character  of  the  pulse. 


FOMENTATIONS   OR   HOT   COMPRESSES  347 

The  use  of  ice  in  pneumonia  rests  upon  the  same  basis. 
The  end  sought  is  not  the  reduction  of  temperature,  but  a  check 
to  the  intoxication  by  improved  circulation  and  consequent 
nutrition.  It  is  possible  that  by  these  means  antitoxins  are 
developed  to  counteract  the  infection.  The  crisis  in  pneumonia 
is  sudden  and  not  fully  to  be  explained.  The  remarkable 
effects  cannot  be  accounted  for  by  immediate  changes  in  the 
physical  condition  of  the  lung.  If  so,  hydrotherapy  would  be 
powerless;  it  is,  therefore,  a  mistake  to  expect  the  compress 
to  cure  the  condition  of  the  lung  itself.  If  the  patient  recovers, 
he  does  so  in  spite  of  the  pulmonary  consohdation;  if  he  dies,  it 
is  not  altogether  from  the  encroachment  on  his  breathing  ca- 
pacity, but  from  the  intoxication. 

Put  two  intoxications  together,  as  that  of  alcohol  and  pneu- 
monia, and  the  result  is  usually  fatal.  As  a  rule,  it  is  not  best 
to  give  alcohol  in  cases  of  pneumonia  treated  with  compresses, 
but  in  alcoholic  cases  some  alcohol  may  properly  be  given, 
but  it  requires  wise  judgment  to  decide  when  to  give  and  when 
to  withhold.  As  in  any  other  form  of  treatment,  little  can  be 
expected  from  these  measures  in  alcoholic  cases,  especially  if 
treatment  be  started  late,  as,  for  instance,  on  the  third  day. 
(See  chapter  on  Pneumonia,  p.  100.) 

ICE   COMPRESSES 

The  apphcation  of  ice  to  the  body  is  best  made  by  means  of 
water-tight  rubber  ice-bags,  as  it  is  obviously  best  to  prevent 
wetting  the  bed  and  the  patient's  clothing.  As  stated  above,  the 
aim  is  not  to  reduce  the  inflammation,  for  the  lungs  of  a  living 
man  would  not  be  appreciably  affected  by  cold  applied  outside 
the  chest  wall. 

FOMENTATIONS!  OR  HOT  COMPRESSES 

Moist  heat  may  be  easily  apphed  to  the  body  b}^  means  of 
hot  flannel  compresses.     Unless  very  hot  compresses  are  used 

!  It  is  tautologic  to  speak  of  hot  fomentations.  They  axe  simply  the  ap- 
plication of  moist  heat  by  means  of  cloths. 


348 


HYDROTHERAPY 


Fig.  117,  a  and  b. — Wringing  hot  compresses  (Cohen). 


FOMENTATIONS   OR  HOT   COMPRESSES  349 

it  is  better  not  to  interpose  linen  or  cotton,  but  to  have  the 
flannel  in  direct  contact  with  the  skin.  The  compress  must 
be  very  thoroughly  wrung  out  of  boiUng  water.  This  tem- 
perature may  be  less  at  first.  This  induces  hyperemia  of  the 
skin  and  reUeves  internal  congestion.  The  compress  should 
be.  covered  with  several  folds  of  flannel  to  prevent  external 
radiation. 

Indications. — Fomentations  or  steam  compresses  have  a  wide 
range  of  usefulness.  They  give  relief  in  almost  any  condition  in 
which  pain  is  a  symptom,  especially  in  those  conditions  in- 
dependent of  inflammation.  When  inflammation  is  present  in 
the  abdominal  cavity,  however,  surgeons  usually  prefer  to 
employ  ice  or  very  cold  applications.  (See  p.  158.)  Hot  com- 
presses favor  suppuration,  promote  the  absorption  of  exudates, 
relieve  pain,  and  increase  the  mobility  of  stiffened  joints.  In 
all  cases  of  rheumatoid  arthritis,  in  arthritis  deformans  with  pain 
and  swelling,  in  sprains,  bruises,  cramps  of  the  extremities;  in 
biliary,  renal,  and  hepatic  colic ;  in  affections  of  the  bowels  and 
pelvic  viscera  and  in  intercostal  neuralgia,  lumbago,  and  sciatica 
moist  hot  compresses  are  exceedingly  useful. 

Counterindications. — Fomentations  are  not  to  be  used  when 
appendicitis  threatens,  or  in  cases  of  peritonitis,  whether  idio- 
pathic, due  to  perforation  of  the  bowel,  or  to  injury.  Pending 
operation,  suppuration  in  such  cases  should  be  fought  with  cold. 
So  also  at  the  onset  of  pneumonia.  In  such  cases  ice-bags, 
cold  compresses,  and  such  measures,  elsewhere  noted,  are  much 
more  stimulant  to  the  vasomotor  centers  and  are  superior  to  the 
general  application  of  heat. 

Technic. — The  illustration  shows  a  convenient  method  of 
preparing  a  steam  compress.  Several  layers  of  white  flannel, 
of  a  suitable  size  and  fastened  together,  are  dipped  into  boiling 
hot  water.  The  area  to  be  treated  is  then  covered  with  a  thin 
layer  of  dry  flannel,  the  so-called  haby  flannel  answers  the  purpose 
best.  The  wet  compress  is  now  dropped  into  a  towel,  and 
twisted  lightly,  so  as  to  leave  it  comparatively  dry.     It  is  then 


350  HYDROTHERAPY 

unfolded,  placed  over  the  dry  flannel  referred  to,  and  the  whole 
enveloped  in  a  dry  flannel  bintler. 

The  following  is  Dr.  Curran  Pope's'  graphic  tlescription  of 
the  application  of  a  hot  compress: 

"I  will  now  simplify  my  ajiparatus  b}-  limiting  it  to  a  basin, 
two  towels,  and  a  tea-kettle  filled  with  boiling  water.  The 
majority  of  hot  applications  fail  for  two  reasons.  In  the  first 
place  the  application  is  too  ivet,  and  in  the  second  the  hot  applica- 
tion is  too  cold.  Hot  applications  should  range  anywhere  be- 
tween 125°  and  165°  F.  (51.7°  and  73.9°  C).  You  cannot 
handle  them  with  your  hands,  in  fact,  they  are  too  hot  for  you 
to  pick  up  and  hold  at  all.  If  you  put  these  applications  on 
the  patient's  skin  too  wet  they  blister.  If  you  put  them  on  only 
warm  you  lose  two-thirds  of  the  benefit  of  the  treatment. 

"Suppose  that  we  are  going  to  make  a  hot  moist  application 
or  fomentation  to  the  pelvis,  where  we  want  all  the  heat  we  can 
get.  It  is  best  to  use  a  Turkish  towel  or  a  small  piece  of  blanket. 
If  you  can't  get  that,  get  a  piece  of  an  old  flannel  petticoat.  Take 
this  and  place  it  right  in  the  center  of  your  towel.  Now  you 
have  everything  ready,  and  the  mistress  of  the  house  brings  in 
the  tea-kettle  full  of  boiling  water.  If  you  were  to  place  it  on 
the  patient  without  previous  preparation,  you  would  burn  her. 
Place  around  the  hips,  pelvis,  and  lower  abdomen  a  folded  blanket, 
so  applied  that  the  ends  overlap  in  front.  Now  rub  the  surface 
to  be  covered  by  the  fomentation  with  vaselin.-  This  prevents 
maceration  or  softening  of  the  superficial  epithelial  layers. 
Having  poured  the  boiling  water  over  the  flannel  that  lies  in 
the  towel,  so  hot  that  you  have  to  keep  back,  two  persons  com- 
mence twisting  the  opposite  ends  of  the  towel  and  keep  twisting 
until  all  or  nearly  all  the  water  has  been  removed.  We  have 
in  this  towel,  we  will  say,  a  piece  of  flannel  at  a  temperature  of 
165°  F.  (73.9°  C),  and  what  does  the  nurse  now  do?  She 
picks  up  the  towel  containing  the  flannel,  goes  to  the  bedside, 

*  Kentucky  Medical  Jour.,  December,  1908. 

2  The  use  of  vaselin  in  this  case  does  not  warrant  its  use  when  dry  heat 
at  much  higher  temperatures  are  used,  as  in  "baking." 


FOMENTATIOXS   OR   HOT   COMPRESSES  351 

rapidly  unrolls  the  towel,  and  places  the  hot  flannel  in  place 
upon  the  bare  skin.  If  the  patient  howls,  lift  it  up  for  a  second, 
and  then  put  it  back  again.  Just  as  soon  as  the  patient  can 
tolerate  the  high  temperature,  the  fomentation  is  covered  by 
the  blanket,  which  is  pulled  as  tight  as  possible  to  prevent  the 
entrance  of  the  air.  There  is  very  little  risk  of  burning  if  plenty 
of  vaselin  has  been  used. 


Fig.  118. — The  Clow  fomentation  sink. 

"Usually  in  less  than  sixty  seconds  you  will  get  a  relief  that 
can  be  gotten  from  no  other  application  that  I  know  of. 

"These  two  procedures  any  doctor  can  use.  It  does  not  make 
any  difference  where  he  is  or  how  he  is  situated." 

A  little  ground  mustard  added  to  the  hot  water  intensifies  the 
action  of  the  fomentation. 

Dry  and  moist  compresses  require  frequent  change  to  be 
effective,  and  if  applied  directly  to  the  skin  should  be  tested 
by  the  physician  or  nurse  before  applying  to  the  patient. 


352 


HYDROTHERAPY 


For  pain,  renewal  may  be  made  every  minute  or  two;  in  less 
severe  cases  every  three  minutes,  having  a  fresh  fomentation 
ready  to  ai)ply  before  removing  the  one  in  place. 

Apparatus. — In  hospital  practice  it  will  be  convenient  to 
have  a  fomentation  sink  with  wringer  and  drain-board,  as  seen 
in  Fig.  118. 

A  simple  invention  for  preparing  compresses  is  described  in 
the  Lancet,*  under  the  name  of  Haden's  Patent  Compress 
Heater. 


Fig.  119  — Appljing  a  f<jim.'ntation  to  the  spine. 

As  will  be  seen  in  Fig.  120,  it  consists  of  a  vessel  in  the 
shape  of  a  truncated  cone,  and  a  pan,  perforated  in  its  cen- 
tral part;  which  fits  into  and  extends  beyond  the  rim  of  the 
smaller  end  of  the  cone-shaped  vessel.  The  diameter  of  the  pan 
is  about  9  inches,  the  perforated  part  measuring  4  inches  across. 
To  each  of  the  two  parts  of  the  apparatus  is  affixed  a  wooden 
handle  which  allows  of  their  being  moved  about  without  risk  of 


1  Haden's  Patent  Compress  Heater,  Lancet,  London,  April  3,  1909.  Manu- 
factured by  Mayer  and  Meltzer,  71  Great  Portland  Street,  W.,  London, 
England. 


FOMENTATIONS  OR  HOT  COMPRESSES 


353 


burning  the  hands  of  the  user.  Water  is  put  in  the  lower  part 
of  the  apparatus,  the  compresses  or  other  articles  are  placed 
upon  the  upper  tray,  and  the  whole  stood  over  a  fire  or  any 
form  of  heating  appliance.  It  will  be  found  that  the  steam 
arising  from  the  water  heats  the  compresses  almost  instantane- 
ously, and  all  risk  of  scalding  the  hands  is  avoided,  as  no  wringing 
is  required.  Another  point  worth  noting  is  that  in  the  absence 
of  a  properly  trained  nurse  the  time  of  the  medical  attendant  is 
saved  in  making  detailed  explanations  and  emphasizing  the 
risks  of  scalding  when  compresses  or  fomentations  are  to  be 
prescribed.  The  appliance  should  be  really  useful  in  hospitals 
in  which  fomentations  are  constantly  being  applied,  for,  as  all 


Fig.  120. — Haden's  patent  compress  heater. 


former  surgical  dressers  are  aware,  the  preparation  of  an  effec- 
tive fomentation  by  means  of  the  old-fashioned  "wringer" 
is  attended  by  considerable  inconvenience.  For  hospital  use 
the  heater  is  made  of  stout  copper,  and  for  less  frequent  employ- 
ment it  is  made  of  tinned  iron  at  a  smaller  cost.  In  the  fomenta- 
tion sink  the  water  is  kept  boiling  by  a  current  of  Hve  steam  pass- 
ing through  the  water. 

In  private  practice  a  large  pail  answers  well,  or,  in  its  absence, 
a  basin  or  a  tea-kettle  filled  with  boiling  water.  There  will  also 
be  needed  two  or  three  towels  and,  if  possible,  a  piece  of  white 
flannel  about  a  yard  square.  A  Turkish  towel  and  a  piece  of 
blanket  can  probably  be  obtained.     (See  Figs.  124,  125.) 

23 


354  HYDROTHERAPY 

Precautions. — In  any  case  where  the  parts  are  insensitive, 
either  from  anesthesia  (hie  to  chsease  or  to  the  use  of  chloroform 
or  ether,  or  if  benumbed  by  cold,  care  should  be  exercised  not 
to  apply  fomentations  at  too  high  a  temperature  or  too  wet. 
Cold  should  always  be  applied  to  the  head.  The  fomentation 
should  be  removed  before  it  has  time  to  cool  and  the  turban  at 
the  head  may  be  used  to  wipe  off  the  ))art  that  has  been  treated. 
This  quick  use  of  a  cool  cloth  will  enhance  rather  than  diminish 
the  effect  of  the  fomentation.  The  part  should  then  be  quickly 
dried  and  covered  with  night  clothing. 

HOT  AND  COLD  TO  THE  SPINE 

Fomentations  to  the  spine  may  be  ai)i)lied  alternately  with 
cold  sponging.  This  process  is  commonly  referred  to  as  "hot 
and  cold  to  the  spine."  It  has  long  been  used  by  Dr.  S.  Weir 
Mitchell  and  other  neurologists  in  the  treatment  of  hysteria, 
neurasthenia,  and  the  irritable  spine. 

The  method  used  varies  in  diflferent  hands.  The  simplest 
is  the  alternate  application  of  two  sponges,  one  dipped  in  hot  and 
the  other  in  cold  water.  Or  three  fomentations  may  be  made, 
each  followed  bj'  a  sponging  with  ice-cold  water.  Each  fomenta- 
tion remains  in  place  three  minutes;  each  sponging  consumes 
fifteen  seconds. 

SALT   RUB   OR   SALT   GLOW 

Requirements.— A  tub  of  salt  water  at  104°  to  105°  F.  (40°- 
40.5°  C.)  and  a  box  containing  finely  ground  salt.  Aston's 
English  salt  is  suitable.  A  small  handful  of  the  salt  is  dampened 
in  salt  water  or  other  convenient  water,  and  the  patient  is 
rubbed  more  or  less  vigorously  by  the  attendant.  After  a 
thorough  rubbing,  the  jDatient  is  washed  off  with  a  rose  carrying 
warm  water,  which  is  gradually  cooled  to  the  desired  temperature. 
A  bath  in  the  full  tub  may  follow  this,  or  may  take  the  place 
of  the  spray,  and  the  patient  should  then  be  well  rubbed  with 
cocoanut  oil  for  fifteen  minutes. 


COLD   APPLICATIONS   UNDER  THE   HEART  355 

THE   ICE  RUB  OR  ICE  IRONING 

In  this  procedure  flat  pieces  of  ice,  held  in  gauze,  are  rubbed 
over  the  body  and  limbs.  It  is  used  in  connection  with  sprink- 
ling and  is  sometimes  advocated  in  serious  cases  of  sunstroke 
(see  p.  92). 


Fig.  121. — Ice  rub. 

The  ice-poultice  is  made  by  mixing  finely  broken  ice  with  dry 
Indian  meal  or  fine  sawdust. 

COLD  APPLICATIONS  UNDER  THE  HEART 

Ice  to  the.  Heart. — This  means  of  combating  fever  is  called 
by  Delearde  and  Dubois  precordial  frigotherapy.^  They  use 
it  in  typhoid  fever  and  other  infectious  diseases,  except  tubercu- 
losis. It  is  applied  day  and  night  throughout  the  continuance 
of  the  fever. 

In  the  use  of  cold  for  children  it  is  especially  necessary  to 

^See  Gazette  Medicale  Beige,  June  18,  1909. 


356 


HYDROTHERAPY 


begin  moderately.  Place  the  ice-bag  to  the  head  and  a  warm- 
water  bag  to  the  feet.  Then  if  desirable,  when  temperature 
remains  high,  place  the  child  on  a  blanket  and  remove  the  cloth- 
ing, except  the  diaper,  and  sponge  with  water  at  90°  to  95°  F. 
(32.2°-35°  C.)  for  ten  minutes,  beginning  with  the  face  and 
taking  up  the  body  and  limbs  in  turn.  It  is  well  to  allow  a  little 
evaporation.  Successive  baths  at  80°  and  70°  F.  (26.6°  and  21.1  ° 
C.)  may  later  be  used,  as  judgment  dictates  and  as  confidence  is 
obtained ;  children  will  gradually  submit  to  these  measures. 


Fig.  122. — Cold  abdominal  or  Neptune  girdle  (Gant). 

NEPTUNE'S  GIRDLE 

This  is  really  an  abdominal  compress  made  with  broad  linen, 
folded  in  several  thicknesses,  and  sufficiently  long  to  pass  around 
the  body  and  overlap  in  front,  so  that  the  abdomen  is  covered 


NEPTUNE  S   GIRDLE 


357 


by  several  thicknesses.  The  binder  is  previously  soaked  in 
water  at  60°  F.  (15.5°  C),  wrung  out,  and  applied  as  described; 
then  covered  with  flannel,  overlapping  the  bandage  above  and 


Fig.  123. — The  ice-coil  in  position  (Gant). 


below,  in  order  to  prevent  access  of  air  and  chilling.     The  linen 
and  flannel  should  be  drawn  up  snug  and  securely  fastened. 

The  ice -coil  accomplishes  very  much  the  same  purpose. 
Winternitz  combined  both  these  measures,  placing  the  coil  above 
the  compress. 


358 


HYDROTHERAPY 


Fig.  124. — Simple  motiiod  of  wrincriiiEr  fnit  fompntation.<;  CGant"). 


Fig.  125. — Method  of  applying  fomentations  (Gant). 


RECTAL   AND   COLONIC   RECTAL   IRRIGATION 


359 


SWEDISH    SHAMPOO 

This  is  a  vigorous  scrubbing  with  soap  and  water,  and  is  a 
feature  of  the  Turkish  bath.  The  Egyptian  loofah  is  used,  and 
stimulates  the  skin  much  better  than 
sponges,  towels,  or  the  bare  hand.  The 
Swedish  shampoo  is  commonly  used 
after  the  warm  full  bath,  and  commends 
itself  to  a  wide  variety  of  cases.  It  has 
been  employed  in  toxic  cases  and  in 
asylum  work  with  great  success. 


RECTAL 


RECTAL 


AND    COLONIC 
IRRIGATION 

This  is  a  valuable  adjunct  to  hydro- 
therapy, and  is  used  in  a  wide  range  of 
affections,  both  medical  and  surgical. 
Most  gastro-intestinal  affections  may  be 
reheved  by  irrigation,  but  for  chronic 
affections,  such  as  chronic  constipation, 
there  is  some  liability  to  overdo  the 
method,  impairing  the  tone  of  the  rectum 
and  the  natural  expulsive  power. 

Rectal  tubes,  and  longer  tubes  for 
insertion  into  the  colon,  may  be  used. 
It  is  highly  necessary,  however,  when 
satisfactory  drainage  is  expected,  that 
provision  be  made  for  a  return  flow. 
There  are  several  two-way  rectal  tubes, 
made  of  glass,  metal,  or  pressed  rubber. 

An  excellent  example  of  the  improved 
rectal  tube  is  that  devised  by  A.  L. 
Wolbarst,  of  New  York.  It  is  made  of 
nickelplated  brass  tubing,  with  a  soft- 
rubber  tip;   the  total  length  is  7  inches, 

including  the  rubber  tip.     The  diameter  is  equivalent  to  38 
of  the  French  scale.      The  soft-rubber  tip  projects  If  inches 


Fig.  126. — Perspective 
view  of  the  Wolbarst  im- 
proved rectal  irrigating 
tube;  two-thirds  natural 
size. 


360  HYDROTHERAPY 

beyond  the  end  of  the  large  tube;  it  is  slipped  over  the  bulbous 
end  of  a  short  metal  tube,  the  distal  end  of  which  is  provided 
with  a  male  thread,  which  is  screwed  into  the  end  of  the  large 
tube  (Fig.  127,  C),  and  thus  securely  wedged  in  place.  We  are 
also  thus  enabled  to  unscrew  the  rubber  tip  and  thoroughly  clean 
it  and  the  metal  tubes  at  will.  The  tip  of  the  instrument  is  of 
soft,  i)liable  rubber,  which  gives  easil)''  on  contact  with  the 
rectal  wall,  and  the  flow  of  fluid  into  the  rectum  is  through  a 
number  of  small  openings,  thus  providing  a  fountain  spray  in- 
stead of  a  single  or  double  jet. 

The  apparatus  consists  of  two  tubes,  a  small  one  inside  of  a 
larger.  The  water  enters  through  the  small  tube  (Fig.  127,  A) 
and  fills  up  the  soft-rubber  pouch  (Fig.  127,  B),  which  is  perfor- 


^/ 


Fig.  127. — Sectional  view  of  the  W^olbarst  improved  rectal  irrigating  tube. 

ated  with  numerous  pin-head  openings,  tlirough  which  the  fluid 
enters  the  rectum.  Escape  from  the  rectum  is  only  possible 
through  the  large  opening  (Fig.  127,  D)  in  the  larger  tube. 
The  external  sphincter  (Fig.  127,  F)  prevents  any  out-flow  at 
the  anus. 

In  cases  where  there  is  an  inflamed  and  tender  prostate,  this 
tube  will  be  more  comfortable  and  satisfactory  to  the  patient 
than  a  rigid  instrument.^ 

Colonic  irrigation  is  especially  useful  in  pediatric  cases. 
It  is  best  to  start  with  water  slightl}'  below  the  patient's  tem- 
perature. If  the  temperature  of  the  child  be  102°  F.  (38.9°  C), 
start  at  95°  F.  (35°  C),  and  in  the  course  of  ten  minutes  reduce 
the  temperature  of  the  fluid  to  about  75°  F.  (23.9°  C).     The 

1  See  Jour.  Amer.  Med.  Assoc,  1909,  vol.  liii,  p.  384. 


PROCTOCLYSIS 


361 


object  to  be  attained  is  not  merely  the  reduction  of  temperature, 
but  the  removal  of  the  products  of  intestinal  decomposition. 
Even  in  the  presence  of  typhoid  fever  good  clinicians  see  no 
objection  to  its  use  as  frequently  as  once  in  three  hours. 

Tympany  is  usually  relieved  by  this  method,  and  the  nor- 
mal salt  solution,  at  very  moderate  pressure,  from  8  to  18 
inches,  tends  to  reduce  quantitatively  toxic  contents  of  the 
bowel.  This  method  has  great  value  in  the  treatment  of  ap- 
pendicitis pending  operation  or  where  surgeons  are  not  available. 


PROCTOCLYSIS 

Dr.  Jolin  B.  Murphy,  of  Chicago,  has  recently  advocated  a 
gradual  method  of  introducing  water  into  the  rectum  under  the 
name  of  proctoclysis.  This  permits  from 
50  to  80  drops  per  minute  to  escape  at 
very  low  pressure. 

Iverson  Apparatus. — ^A  simple  appa- 
ratus for  this  process  is  one  devised  by 
Dr.  M.  Iverson,  of  Stoughton,  Wisconsin, 
of  which  Fig.  128  is  a  diagram.^  The 
parts  of  this  instrument  consist  of  a 
fountain  syringe  or  irrigator  (a),  a  stop- 
cock (6),  a  Y-shaped  glass  tube  (c). 
From  the  latter  a  long  rubber  tube, 
ending  in  a  hard-rubber  or  glass  tip, 
extends  downward,  and  another  piece  of 
tubing  extends  upward,  ending  in  a 
U-shaped  glass  tube  (d) ,  the  open  end  of 
which  projects  into  the  irrigator.  An  8- 
candlepower  incandescent  electric  drop- 
light  (e)  is  all  that  is  necessary  to  main- 
tain the  temperature  of  the  saline  solu- 
tion. 

The  stop-cock  is  set  so  as  to  permit  a  flow  of  from  50  to  80 
drops  a  minute.     The  vent  tube  leading  from  ctod  permits  the 

^  Jour.  Amer.  Med.  Assoc,  June  12,  1909. 


Fig.  128. — Iverson's  appa- 
ratus for  proctoclysis. 


362 


HYDKOTHEKAPY 


back  flow  of  liquid  or  the  passage  of  gas  when  the  patient  strains. 
Tiie  container  should  be  from  4  to  14  inches  above  the  level  of 
the  buttocks. 

Dr.  Murphy  employs  this  method  in  the  treatment  of  peri- 
tonitis,   whether   postoperative   or   otherwise,   and   in   general 

toxemic  conditions.  Its  value  de- 
pends on  the  absorption  of  large 
cjuantities  of  water  by  the  intestine, 
and  this  is  possible  only  when  small 
cjuantities  are  continuously  supplied 
at  a  uniform  heat  under  very  moder- 
ate pressure.  Hypcrdistention  causes 
spasm  and  expulsion  of  the  fluid  sup- 
plied, and  it  must  be  avoided.  The 
apparatus  already  described  fulfils 
these  requirements,  but  any  fountain 
syringe  may  be  used  if  it  be  provided 
with  a  vaginal  hard-rubber  or  glass 
tip,  flexed  at  an  obtuse  angle  2  inches 
from  its  end,  as  seen  in  Fig.  129.^ 
The  tip  should  be  inserted  into  the 
rectum,  so  that  the  angle  fits  closely 
to  the  sphincter.  The  tube  may 
then  be  bound  firmly  to  the  thigh 
with  adhesive  strips,  so  that  it  can- 
not be  expelled.^ 
The  bag  or  container  is  suspended  near  the  foot  of  the  bed, 
so  that  the  base  is  6  inches  above  the  level  of  the  patient's  but- 
tocks. The  solution  advised  by  Dr.  Murphy  consists  of  a  dram 
each  of  sodium  chlorid  and  calcium  chlorid  to  the  pint  of  water. 
This  is  placed  in  the  reservoir  and  kept  at  a  temperature  of  100° 
F.  (37.7°  C.)  by  the  most  convenient  method — electric-light 
bulb,  thermos  bottles,  thermolytes,  or  a  metal  chamber  having 
an  electric-heating  unit  and  rubber  tube,  as  illustrated  below. 

1  See  Journal  Amer.  Med.  Assoc,  April  17,  1909,  pp.  1248-1250. 

2  See  Kelly  and  Noble,  Gynecology  and  Abdominal  Surgery,  vol.  ii,  p.  415. 


Fig.  129. — PnKtoclysis  ap- 
paratus, consisting  of  fountain 
syringe,  large  rubber  tube,  and 
vaginal  hard-rubber  or  glass 
tip. 


PROCTOCLYSIS 


363 


The  quantity  administered  depends  on  the  severity  of  the 
case,  the  age  of  the  patient,  and  other  considerations  that  will 
suggest  themselves  in  the  particular  instance.  The  average, 
however,  is  18  pints  in  twenty-four  hours;  that  is,  li  pints 
every  two  hours.     A  quantity  less   than  8  pints   is  of   little 


Fig.  130. — Elbrecht's  apparatus,  representing  a  metal  heating  chamber,  block 
tin  lined,  with  opening  for  electric  heating  unit  and  rubber  tube  connections  for 
intake  and  outlet  of  saline  solution.      (One-third  size.) 

value.  In  a  child  of  eleven  as  much  as  30  pints  have  been  ad- 
ministered in  twenty-four  hours  without  escape  of  fluid.  The 
control  of  the  flow  should  never  be  governed  by  knots  in  the  tube, 
forceps  clamped  thereon,  or  small  openings  in  the  tip.  The  larger 
tube  with  many  openings  is  used  to  provide  for  a  sudden  return 


Fig.  131. — Electric  heating  unit  with  socket  connection  and  10  feet  of  cord. 
This  unit  can  be  used  with  either  alternating  or  direct  current,  105  to  128  volts. 
(See  Fig.  130.)      (One-third  size.) 

of  the  flow  into  the  can  when  the  patient  strains,  wishes  to  expel 
the  fluid,  or  void  gas.  If  there  be  constrictions  in  the  tube  the 
fluid  cannot  return  into  the  can,  but  passes  into  the  bed-linen. 

Elhrecht  Apparatus. — A  more  elaborate  form  of  apparatus  is 
that  devised  by  Dr.  0.  H.  Elbrecht,  of  St.  Louis,  and  manu- 
factured by  the  Meier  Dental  Manufacturing  Company  of  that 


364 


HYDROTHERAPY 


city  (Figs.  130-137).     Dr.  Elbrccht  describes  his  apparatus  as 
follows : 

"The  proctoclysis  heating  apparatus  illustrated  was  designed 
to  meet  a  demand  for  an  outfit  that  would  hoat  saline  and 
maintain  it  at  a  uniform  temperature  for  proctoclysis.  Many 
varieties  of  heating  devices  have  been  employed,  but  all  are 
found  wanting,  in  that  they  fail  to  maintain  a  uniform  tempera- 


Biiaj 


Bl 


Fifj.  132. — Heat  unit  for  alcohol  or  Riinsen  burner  flame  with  regulating  pis- 
ton. For  use  where  electric  current  is  not  available.  (See  Fig.  130.)  (One-third 
size.) 

ture  when  heat  is  applied  to  the  saline  reservoir,  for  the  saline 
is  ever  changing  in  amount  as  a  result  of  absorption,  and  thus 
brings  about  ever-changing  temperatures.  Then  also  there  is 
a  great  loss  of  heat  in  the  rubber  tubing  from  the  burner  or 
alcohol  lamp  in  connection  with  the  heating  chamber,  which 
is  then  placed  on  a  small  table  alongside  of  the  bed  (Fig.  137). 


Fig.  133. — Self-retaining  rectal  tips  on  catheter,  showing  how  adjustment  can 
be  accomplished  by  merely  drawing  catheter  through  to  desired  length.  (One- 
half  size  of  largest  rectal  tips.) 

This  permits  the  outfit  to  be  used  where  electricity  is  not  avail- 
able, as  in  rural  districts  or  in  homes  where  only  gas  is  at  hand. 
All  the  parts,  including  saline  tablets,  are  assembled  in  a  box, 
which  makes  the  apparatus  portable  and  ready  for  immediate 
use  in  emergencies." 

Dr.  Elbrecht's  apparatus  works  admirably  in  adults.  It  can 
be  used  with  the  angled  vaginal  douche-tip  as  well  as  with  the 


PROCTOCLYSIS 


365 


bulb-tip  inserted  in  the  rectum.     The  tip  may  be  better  than 
the  bulb,  as  the  latter  occasionally  produces  irritation  and  the 


Fig.  134.— Pinch- 
cock  used  entirely  to 
close  flow  or  for  drop 
method.  (One-half 
size.) 


Fig.  135. — Self-retaining  rectal  tips  made  in  four 
sizes  of  hard  rubber  with  opening  through  center  to  ad- 
mit a  soft-rubber  rectal  catheter,  American  size,  No.  15. 
(See  Fig.  133.)     (One-third  size.) 


Fig.  136. — Elbrecht's  apparatus:    Electric  heater  in  operation,  showing  it  prop- 
erly connected.     A  short  glass  tube  connects  catheter  to  rubber  tubing. 

patient  insists  on  having  it  removed.     For  the  maintenance  of 
uniform  heat  the  Elbrecht  apparatus  fulfils  all  the  indications. 


366 


HYDROTHERAPY 


It  does  not.  however,  allow  the  fluiel  to  How  back  when  the  patient 
strains.  Tiio  liokler  of  the  Elbrecht  apparatus  may  be  inserted 
into  the  ortlinary  fountain  syringe  can  containing  hot  water, 
and  that  keeps  it  at  a  uniform  temperature  and  moderately 
warm  for  a  long  period  of  time. 

Dr.  Gordon  J.  Saxon  has  devised  an  apparatus,  which  con- 
sists of  a  copper  bucket  standing  on  substantial  brass  legs,  to 
contain  boiling  water;   with  a  handle  to  suspend;  a  lid  to  pre- 


Fig.  137. — Elbrecht'b   apparatus:    Alcohol  or  f;:i-  iu-.-iicr  in  opcr.-ition,  showing  it 
properly  connected.     A  short  glass  tube  connects  catheter  to  rubber  tubing. 


vent  excessive  heat  radiation;  faucet  at  side  for  the  quick 
emptying  of  contents  for  purpose  of  replenishing  with  hot  water; 
a  circular  opening  at  bottom  provided  with  rubber  washer; 
a  graduated  jar  of  1000-cc.  capacity,  to  receive  the  salt  or  other 
solution  at  about  140°  F.  (60°  C),  its  off-flow  protruding  through 
the  opening  and  pressing  firmly  against  the  washer,  while  the 
jar  is  held  in  position  inside  by  a  metal  frame  and  clamps. 
The  off-fiow  tube  consists  of  two  sizes  of  rubber  tubing  fitted 


PROCTOCLYSIS 


367 


within  each  other,  but  separated  by  asbestos  wrapping  between 
them  to  retain  heat.  At  the  end  near  the  glass  rectal  nozzle 
a  thermometer  is  interposed  for  the  frequent  reading  of  the 
temperature  of  the  solution  at  that  point  and  as  a  guide  to  the 
rapidity  of  the  flow.  If  the  flow  be  too  slow,  the  mercury  falls, 
and  if  too  rapid,  the  mercury  rises. 

About  12  inches  from  the  outlet  of  the  jar  a  Y-tube  is  inter- 
posed, of  which  the  free  part  (shunt  tube)  is  connected  to  a  re- 
ceiving glass  bottle  open  at  top  (shunt  bottle) ,  which  is  secured 
to  the  side  of  the  bucket.     The  purpose  of  this  shunt  bottle  is 


Fig.  138. — Saxon's  apparatus  for  proctoclysis. 


to  permit  the  ready  expulsion  of  solution  or  flatus.  For  the 
control  of  the  flow  a  pinch-cock  is  placed  between  the  outlet  of  the 
solution  jar  and  the  Y-tube. 

A  glass  float  is  also  provided  in  order  to  more  readily  estimate 
the  quantity  of  solution  retained  in  jar,  in  a  room  where  the 
light  is  subdued  and  the  graduations  on  jar  not  distinctly  visible. 

The  purpose  of  the  apparatus  is  to  keep  the  solution  to  be 
introduced  at  an  almost  even  temperature,  so  that  it  will  enter 
the  rectum  at  a  temperature  of  between  105°  to  115°  F.  (40.5°- 
46.1°  C),  even  during  apphcation  lasting  a  number  of  hours. 


368  HYDROTHERAPY 

According  to  experiments,  it  will  not  be  found  necessary  to 
change  the  warming  fluid  more  often  than  once  in  two  to  two 
and  one-half  hours. 

Directions  for  Use,  as  Suggested  by  Dr.  Saxon. — "Fill  the 
warming  chamber  with  boiling  water.  Fill  the  reservoir  with 
salt  solution  at  about  120°  to  140°  F.  (48.8°-60°  C).  Open  the 
pinch-cock  and  allow  the  fluid  to  flow  freely  until  the  tube  is 
well  warmed.  Close  the  pinch-cock  until  about  2  ilrops  per 
second  are  flowing.  To  judge  this,  hold  the  rectal  tube  point 
upward  not  more  than  4  inches  below  the  level  of  the  water  in 
the  reservoir;  otherwise  one  will  be  deceived  by  the  rapidity 
with  which  the  tube  will  empty  itself  distal  to  the  stop-cock  when 
the  rectal  nozzle  is  held  too  low. 

"  Place  the  rectal  tube — of  the  type  directed  by  Murphy — in 
the  rectum  and  strap  to  the  inner  surface  of  the  thigh.     Place 


Fig.  139. — Irrigating  or  infusion  thermometer  for  measuring  the  temperature 
of  saline  sohition,  or  by  cutting  the  rubber  tube  it  can  be  inserted  between  the 
irrigator  and  the  patient  by  slipping  the  tube  over  each  end  of  the  glass  tube  that 
holds  the  thermometer. 

the  apparatus  on  an  adjustable  stand  or  chair,  4  to  10  inches 
above  the  level  of  the  anus.  A  curved  glass  douche  nozzle 
with  multiple  openings  answers  ver}'  well  the  purpose  of  a 
rectal  tube  when  the  patient  is  supine.  The  flow  should  be  just 
within  the  internal  sphincter. 

"  If  the  solution  be  expelled  into  the  bed  or  back  of  the  shunt 
bottle,  the  apparatus  may  be  lowered,  thereby  decreasing  slightly 
the  rate  of  flow.  If  the  patient  persists  in  expelling  the  solution, 
discontinue  the  treatment  for  one  hour  and  then  proceed  as 
before. 

"  In  order  to  save  the  patient  the  excitement  incident  to  pre- 
paring and  adjusting  the  apparatus,  it  will  be  found  desirable 
to  make  all  preparations  before  entering  the  patient's  room,  so 
as  to  be  ready  for  instant  use  when  approaching  the  bedside. 

"  To  do  this,  fill  the  reservoir  with  solution  as  directed  and 


PROCTOCLYSIS 


369 


allow  the  flow  to  begin.  Place  the  rectal  tube,  point  upward, 
about  1  inch  below  bottom  of  apparatus.  Reduce  the  rate  of 
flow  by  means  of  the  pinch-cock  until  the  solution  can  be  seen 
to  be  making  slow  progress  upward  in  the  upheld  rectal  tube. 
This  will  be  drop  by  drop.     Place  a  hemostat  on  the  rubber  tube 


Fig.  140. — Double-current  rectal  irrigation  apparatus  used  at  Chatel-Guyon. 


just  proximal  to  the  rectal  tube,  and  remove  after  rectal  tube 
has  been  introduced  and  securely  strapped  to  the  inner  surface 
of  the  thigh  by  means  of  adhesive  plaster." 

Value  of  Murphy- Fowler  Method. — This  method  of  Murphy's 
in  the  Fowler  position,  or  the  Murphy-Fowler  method,  as  it  is 
called,  is  a  distinct  advance  in  therapeutics,  and  we  are  glad 

24 


370  HYDROTHERAPY 

to  include  it  among  hydrotherapeutic  measures.  Its  use,  along 
the  lines  laitl  down,  has  reduced  the  mortality  of  diffuse  sup- 
purative peritonitis  from  the  high  rate  of  70  or  80  per  cent,  to 
less  than  10  per  cent.  Murphy  recently  reported  recovery  in  51 
cases,  including  5  typhoid  fever  perforations,  all  severe.  Stuart 
McGuire  reports  18  cases  with  but  1  death,  and  other  surgeons 
are  no  doubt  having  equally  satisfactory  results.* 

The  semisitting  position  has  some  objections,  which  can  be 
relieved  by  raising  the  head  of  the  bed  and  keeping  the  patient 
on  his  right  side.     This  position  should  be  adopted  at  the  outset. 

In  various  places  in  France  intestinal  irrigation  with  natural 
mineral  water  is  rather  commonly  used.  This  is  done  at  Aix-les- 
Bains,  but  special  attention  is  given  to  this  form  of  treatment 
at  Chatel-Guyon  in  Auvcrgne  and  at  Plombieres.  We  recently 
found  in  Paris  an  ingenious  double-current  rectal  irrigation 
apparatus  that  is  employed  at  Chatel-Guyon.  The  natural 
gaseous  muriated  water  is  introduced  at  low  pressure  at  100.4° 
to  118.4°  F.  (38°-48°  C.)  by  means  of  the  long  rectal  tube,  which 
passes  through  a  larger  and  much  shorter  tube  inserted  in  the 
anus.  A  return  flow  is  provided  for  as  in  Fig.  140.  This  appa- 
ratus is  intended  for  either  a  high  or  low  irrigation. 

THE  VAGINAL  DOUCHE 

To  be  effective  this  should  be  much  more  abundant  than  is 
usually  given.  To  obtain  the  best  results  the  ordinary  fountain 
syringe  does  not  suffice,  because  the  cjuantity  of  water  should 
be  from  20  to  25  gallons,  if  possible,  at  a  temperature  of  113°  F. 
(45°  C),  Such  douches  form  a  feature  of  the  method  used  at 
Luxeuil,  France.  Special  apjmratus  providing  for  drainage  by 
return  current  is,  of  course,  necessary. 

Position. — The  technic  calls  for  a  special  position — the  knee- 
chest  position — in  which  the  hips  are  high  and  the  body  slightly 
lowered,  so  that  the  pelvic  and  abdominal  organs  are  not  only 

^  Surgery,  Gynecology,  and  Obstetrics,  June,  1908;  Jour.  Amer.  Med. 
Assoc,  March  8,  1908.  See  also  Kothe  on  Continuous  Irrigation  of  the  Rec- 
tum by  Salt  Solution  at  100°  F.,  Therapie  der  Gegenwart,  No.  10,  1907. 


THE   VAGINAL   DOUCHE  371 

relieved  of  their  own  weight,  but  incHne  toward  the  diaphragm. 
The  capacity  of  the  vagina  is  increased,  and  the  cervix  uteri 
and  vaginal  walls  are  thus  more  effectively  reached  and  influenced 
by  the  heat  of  the  douche.  All  gynecologists  seem  to  agree 
that  full  douches  should  do  more  than  merely  wash  out  the 
vagina. 

These  douches  are  indicated  in  uterine  congestions;  in  the 
case  of  pain,  hemorrhage,  and  dysmenorrhea  occurring  in 
nervous  arthritic  patients;  in  pelvic  infections  where,  for  special 
reasons,  operations  cannot  be  performed.  In  any  case,  there 
may  be  great  palliation  of  symptoms,  and  douches  of  this  magni- 
tude regularly  employed  may  limit  or  entirely  remove  the  neces- 
sity for  surgical  interference.  In  the  presence  of  exudates 
and  tumefactions  of  the  adnexa  it  would  be  prudent  to  give 
this  method  a  thorough  trial. 

Pozzi  states  that  in  acute  metritis  vaginal  douches  of  113° 
to  122°  F.  (45°-50°  C),  kept  up  for  a  long  time,  are  of  great 
service;  also  in  chronic  metritis,  more  or  less  pronounced,  and 
in  sensitive  patients  who  complain  of  acute  pain.  They  deplete 
the  parts  by  stimulating  the  circulation,  and  are  at  the  same  time 
something  of  a  local  sedative.  If  properly  used,  they  give  rehef 
in  congestion  of  the  vagina  and  uterus,  and  in  cellulitis,  when  the 
inflammation  is  hmited  to  the  cellular  tissue  about  the  cervix 
uteri. 

Dr.  A.  J.  Skene  gives  credit  to  Dr.  T.  A.  Emmet  as  being 
the  first  in  the  United  States  to  popularize  the  method. 

The  French  are  using  quite  generally  hot  vaginal  douches  for 
pelvic  infections  and  Uterine  congestion.  While  they  do  not 
cure  a  cervical  metritis,  they  prepare  the  way  for  other  treatment. 
But  in  an  infection  extending  to  the  adnexa;  in  pelvic  peritonitis; 
well  locahzed  salpingitis  with  slight  swelling  with  enlarged  and 
fixed  uterus;  or  in  diffuse  lymphangitis  without  much  swelling 
but  causing  adhesions,  these  douches  are  especially  valuable. 
Richelot  also  describes^  what  is  termed  "arthritiques  nerveuses," 
a  class  of  non-infectious  maladies  variously  described  as  uterine 

^  Bulletin  de  I'Academie  de  Medicine,  November  17,  1908. 


372  HYDROTHERAPY 

angiosclcrosis,  dystrophic  troubles  in  young  girls,  with  mcnor- 
rhagia  and  leukorrhea  and  intermenstrual  dysmenorrhea;  and  a 
class  designated  as  ''metrite  douleureuse  chronique." 

Patients  having  these  various  affections  have  been  very  suc- 
cessfully treated  in  the  excellent  hydrotherapeutic  estabUshment 
in  Paris,  conducted  by  Dr.  Derecq,  and  recently  visited  by  the 
author.  We  were  especially  impressecl  with  the  personal  atten- 
tion to  details  given  by  the  director  of  this  establishment.^ 

PUBLIC    BATHS 

The  Greeks  and  Romans  established  public  baths  on  elabor- 
ate scales,  and  provided  them  with  all  sorts  of  attractions  for 
the  different  grades  of  citizens.  Msecenas,  the  favorite  of 
Augustus,  introduced  public  baths  in  Rome,  and  this  became 
an  expression  of  popularity.  Military  heroes  presented  magnifi- 
cent batlis  to  the  city,  so  that  it  is  said  that  there  were  as  many 
as  937  of  these  in  Rome  at  one  time.  They  were  free  to  all 
classes.  In  the  course  of  time  the  public  baths  were  employed, 
not  so  much  for  hygiene  as  for  dissipation  and  display.  The 
fact  that  both  sexes  occasionally  bathed  together  led  to  such 
irregularities  that  legal  enactment  forbade  all  women  from  such 
participation  who  did  not  belong  to  the  class  of  impudicco  mulieres 
(Garnett). 

In  the  famous  baths  of  Caracalla  there  were  places  for  1600 
bathers,  and  in  the  Diocletian  baths  3600  persons  could  bathe 
at  the  same  time.  During  the  reign  of  the  Caesars  Rome  pos- 
sessed 11  large  public  baths  and  926  smaller  ones,  in  all  accom- 
modating 62,800  individuals.  Rome  certainly  held  the  record 
for  public  bathing. 

The  baths  of  Pompeii  were  discovered  in  a  complete  state 
of  preservation,  the  ornaments  and  inscrijjtions  being  found 
intact.  There  were  several  apartments  which  freely  com- 
municated with  each  other,  and  in  which  baths  of  different 

^  See  also  P.  Dalche,  Traitement  hydrotherapique  dans  les  Maladies  des 
femmes,  La  Gynecologie,  July,  1908.  In  Germany  excellent  reports  have 
been  made  by  Treub,  Doderlein  and  Pfannenstiel. 


PUBLIC   BATHS 


373 


temperatures  were  furnished.  The  section  here  presented,  of 
a  Pompeian  bath-house,  is  taken  from  the  work  of  Sir.  W.  Gell, 
and  his  explanations  have  been  adopted,  to  a  certain  extent,  in 
this  sketch. 

The  court  was  a  large  room  in  which  assembled  all  visitors, 
before  taking  the  bath,  and  from  it  they  passed  to  the  various 
baths — some  went  to  the  frigidarium,  where  the  cold  bath  was 
taken,  or  into  the  natatorium,  for  the  purpose  of  swimming — 


Fig.  141. — Section  of  Pompeian    bath:    20,  The  court;    17,  the  frigidarium  (old 
bath);   15,  tepidarium. 

the  natatorium  of  the  baths  of  Diocletian  was  200  feet  long,  by 
100  feet  in  width,  giving  ample  space  for  this  athletic  exercise. 

The  tepidarium  was  a  room  filled  with  warm  air  of  an 
agreeable  temperature  (110°  to  115°  F.— 43.3°-46.1°  C), 
wherein  the  anointing  of  the  person  with  rich  unguents  was 
performed.  In  this  roomi  were  placed  long  seats,  upon  which 
the  bathers  sat.  "The  hearth  (of  the  tepidarium)  is  about  7 
feet  long,  and  2  feet  6  inches  broad.  It  is  of  bronze,  and  is 
ornamented  by  thirteen  battlemented  summits  and  a  lotus  at 
the  angles.     Within  these  is  an  iron  lining,  calculated  to  resist 


374  HYDROTHERAPY 

the  heat  of  the  embers,  and  the  bottom  is  formed  by  bars  of 
brass,  on  which  are  laid  bricks  supporting  the  pumice  stones 
for  the  reception  of  the  charcoal.  This  ai)artment  was  decorated 
in  a  manner  suitable  to  its  appearance.  The  pavement  of  white 
mosaic,  with  two  small  borders  of  black,  the  ceilings  elegantly 
painted,  the  walls  covered  with  crimson,  and  the  cornice  sup- 
ported by  statues,  all  assist  in  rendering  this  a  beautiful  and 
splendid  place  of  relaxation  for  the  inhabitants  of  Pompeii. 
The  cornice  begins  at  4  feet  3  inches  above  the  pavement,  and 
is  1  foot  2f  inches  high,  the  abacus,  which  is  5^  inches, 
included.  Above  this,  the  figures  (Telamones)  with  the  en- 
tablature rise  to  the  height  of  3  feet  5  inches  more,  and  above 
there  is  the  flowery  Corinthian  tracery.  These  figures  are  about 
2  feet  in  height,  stand  upon  little  square  plinths  or  dies,  3 
inches  high,  and  hold  their  arms  in  a  posture  fitted  for  assisting 
the  head  to  bear  the  superimposed  weight.  They  are  of  terra- 
cotta, and  stand  with  their  backs  placed  against  square  pilasters, 
projecting  1  foot  from  the  wall,  and  with  an  interval  of  1  foot 
3j  inches  between  each.  The  use  of  these  figures  in  the  baths 
of  Pompeii,  by  whatever  name  the}^  may  have  been  called, 
was  evidently  to  ornament  the  separations  between  the  number 
of  niches  or  recesses,  in  which  the  garments  of  those  who  went 
into  the  sudatorium,  or  inner  apartment,  to  perspire,  were  laid 
up  till  their  return." 

The  third  apartment.  No.  12,  held  the  hot  baths,  and  was 
called  the  calidarium.  It  had  at  one  end.  No.  13,  a  raised  plat- 
form, upon  which  was  placed  a  cistern  of  hot  water,  and  was 
capable  of  accommodating  10  or  15  bathers  at  one  time.  At 
the  other  extremity  was  the  labnim,  from  which  flowed  a  con- 
stant stream  of  cold  water,  used  for  lessening  the  cerebral  circula- 
tion when  too  highly  stimulated  by  the  hot  bath.  This  compart- 
ment was  heated  with  hot  air  and  steam. 

Excavation  of  Famous  Baths  in  Greece. — It  is  announced 
from  Greece  that  the  buildings  of  the  baths  at  iEdepsos,  in 
Eubcea,  have  been  discovered  and  excavated.  The  baths  were 
verj'^  famous  in  anticjuity;  but  no  traces  of  the  buildings  could 


SHOWER-BATHS  375 

be  discovered,  owing  not  only  to  the  natural  accumulations  of 
soil  above  them,  but  to  the  incrusting  action  of  the  minerals 
in  the  springs.  The  discovery  was  accidental  and  the  buildings 
were  soon  laid  bare.  The  main  building  is  round,  with  a  wait- 
ing room  decorated  with  pillars  and  statues.  The  second  story 
evidently  served  as  a  reservoir  for  the  water,  with  tubes  to 
convey  it  to  the  room  below.  The  absence  of  any  sink  or  de- 
pression in  the  floor  suggests  that  the  baths  must  have  been 
taken  in  portable  wooden  tubs.  Another  building  evidently 
served  for  public  baths,  and  was  arranged  accordingly,  also 
decorated  with  statues.  The  Allg.  med.  Ct.-Ztg.  states  that  the 
springs  of  ^clepsos  have  been  flowing  until  recent  times  as 
in  antiquity,  but  the  local  authorities  recently  tried  to  in- 
crease the  flow  with  a  dynamite  charge,  the  result  being  the 
complete  disappearance  of  the  springs. 

In  England,  Peter  Chamberlen  ^  was  the  first  to  advocate 
public  baths. 

SHOWER-BATHS 

There  are  about  100  of  these  in  thirtj^-f our  cities  of  the  United 
States,  and  nearly  all  have  been  estabhshed  since  1890.  Floating 
baths  had  been  established  previously  in  New  York,  Brooklyn, 
and  Boston,  and  Philadelphia  and  Chicago  had  pools,  but  all 
these  were  used  only  during  the  milder  portion  of  the  year.  It 
was  owing  to  the  active  influence  of  Dr.  Simon  Baruch,  of  New 
York,  who  made  the  first  plea  for  rain  or  shower-baths  in  this 
country  in  1889,  that  so  much  has  been  done  to  give  the  poor 
practical  bathing  facilities. 

As  chairman  of  the  Committee  of  the  County  Medical  Society 
of  New  York  he  recommended  that  pubMc  baths  be  located  in  the 
very  center  of  the  overcrowded  districts.  The  buildings  should 
be  modest  in  style,  so  as  not  to  repel  the  poor;  they  should  be  so 
constructed  that  a  cleansing  bath  may  be  obtained  without 
trouble  and  expense,  or  at  a  trifling  expense,  and  without  much 
loss  of  time.     This  idea  that  public  baths  should  be  cleansing 

1  Peter  Chamberlen,  A  Vindication  of  Public  Artificial  Baths  and  Bath 
Stories,  London,  1648. 


376  HYDROTHERAPY 

always  and  free  as  public  parks  has  been  adopted  by  many 
municipalities  in  the  United  States.  (Sec  Government  Report 
No.  54,  Louisiana  Exposition,  1904.  Bulletin  of  the  Bureau  of 
Labor.) 

Following  the  German  jjlan,  warm  rain  or  shower-baths 
were  substituted  for  the  old-fashioned  bath-tub.  These  are 
supplied  from  reservoirs  of  some  height,  affording  considerable 
pressure.  The  outlay  for  tubs  and  their  necessary  care  are 
avoided.  The  time  for  a  shower-bath  is  far  less,  and  there  is 
much  greater  economy  of  space  and  in  the  quantity  of  water 
needed,  requiring  only  one-tenth  the  amount  of  water.  There 
is  no  danger  in  communicating  disease.  The  refreshing  effect 
of  the  shower,  the  temperature  of  which  may  be  gradually  re- 
duced after  cleansing,  is  valuable,  and  prevents  danger  from 
the  relaxing  effects  of  the  warm  tub-bath. 

At  the  Volksbad,  in  Vienna,  70  persons  can  be  accommodated 
at  once,  and  for  5  kreutzer  (2  cents)  the  bather  receives  a  towel, 
an  apron  or  mantle,  a  piece  of  soap,  and  a  key  to  a  closet  where 
he  places  his  clothing.  He  turns  the  w^ater  on,  soaps  himself 
thoroughly,  and  again  opens  the  valve  of  the  shower,  which 
descends  with  so  much  force  that  it  aids  the  bather  in  the  cleans- 
ing process.  In  five  minutes  he  finds  himself  more  clean  than 
he  would  become  in  a  longer  period  in  a  tub-bath,  the  water  of 
which  must  become  soiled  before  its  termination.  The  w^ater 
is  quickl}^  drained  away,  and  the  apartment  is  soon  ready  for 
another  occupant. 

It  was  pointed  out  that  a  river-bath  in  summer  is  not  to 
be  compared  in  efficacy  with  the  warm  shower-bath  in  a  well- 
lighted,  well- ventilated,  pleasantly  warm  room,  with  facilities 
for  drying  and  dressing. 

The  New  York  Association  for  Improving  the  Conditions 
of  the  Poor  established  on  these  lines  the  "Peoples  Bath"  and 
other  baths. 

The  floating  baths  of  New  York  have  a  record  of  over  5,000,000 
baths  a  year,  and  the  municipal  pool  baths  of  Philadelphia 
nearly  as  many.     When  the  present  structures  are  completed, 


SEA-BATHS  377 

10,000,000  baths  will  be  available  annually.  The  park  depart- 
ment, under  Commissioner  Stover,  is  making  active  ■  progress 
toward  this  most  worthy  end.  In  the  slum  districts  of  our 
largest  cities  few  have  private  bathing-tub  facilities.  In  such 
districts  in  New  York  City,  93.5  per  cent,  are  without  them;  in 
Chicago,  96.2  per  cent.;  in  Baltimore,  90.8  per  cent.,  and  in 
Philadelphia,  82  per  cent.  The  need  of  greater  bathing  facili- 
ties is  very  great.  In  visiting  480  houses  in  the  selected  dis- 
trict in  New  York  but  17  had  bath-rooms ;  and  in  378  houses  in 
Philadelphia  67  had  bath-rooms. 

The  author,  with  Dr.  Baruch,  visited  the  Riverside  Associa- 
tion Bath  in  West  6th  Street,  New  York  City,  and  was  most 
favorably  impressed  with  the  system  of  rain  baths,  hot-air  baths, 
circular,  jet,  and  Scotch  douches,  as  afforded  at  nominal  cost  for 
the  poorer  classes. 

The  Philadelphia  Public  Baths  Association  conducts  3  bath- 
houses, and  furnished  over  100,000  baths  in  1904,  at  a  cost  of  5 
cents  to  each  bather.  In  these,  pool  baths  are  employed.  In 
addition,  Philadelphia  has  18  public  bath-houses  equipped  with 
pools;  they  are  open  in  summer  from  6  a.  m.  to  9  p.  m.  In 
1907  as  many  as  506,152  persons  bathed  in  one  week,  and  over 
5,000,000  baths  are  given  annually.  They  are  open  to  men, 
women,  boys,  and  girls.  For  1906  the  figures  were  5,675,000; 
for  1907,  4,809,893.  In  Chicago  there  were  671,104  bathers  in 
the  public  baths  in  1906,  and  577,684  in  1907.  The  compara- 
tively cool  summer  of  1907  accounts  for  the  reduction  in  the 
numbers. 

SEA-BATHS 

The  important  features  of  the  sea-bath  are  the  temperature, 
ranging  from  55°  to  75°  or  80°  F.  (10°-23.9°  or  26.7°  C);  the 
force  of  the  waves;  the  effect  of  the  salt  in  solution,  1.6  per  cent., 
on  the  skin,  and  the  opportunity  for  exercise  in  the  bath.  These 
are  elements  of  great  power  for  good  or  evil,  and  very  little 
consideration  is  given  to  them  by  the  hundreds  of  thousands  of 
bathers  during  the  summer  months. 


378  HYDROTHERAPY 

AVintcr  sea-bathing  is  i)opular  on  the  Florida  coast  and  at 
Coronaclo,  Cahfornia.  The  temperature  of  the  water  at  Palm 
Beach  averages  70°  F.  (21.1°  C.)  or  higher  in  January  and  Feb- 
ruary, and  56°  to  58°  F.  (13.3°-14.4°  C.)  at  Coronado.  At  San 
Francisco  it  is  about  52°  F.  (11.1°  C.)  the  year  round.  The  Gulf 
Stream  emerges  from  the  Gulf  of  Mexico  in  a  narrow  channel 
between  Florida  and  Cuba,  and  follows  the  coast  until  it  is 
about  65  miles  distant  from  shore  at  Atlantic  City.  Its  center 
is  135  miles  from  Atlantic  City  and  about  185  miles  distant 
from  Sandy  Hook.  Its  influence  is  not  felt  very  much  on  the 
New  England  coast  beyond  Cape  Cod. 

At  ^'irginia  Beach  bathing  is  good  May  1st;  on  the  New 
Jersey  coast,  as  early  as  June  1st;  on  the  New  England  coast 
beyond  Boston,  by  the  cntl  of  June.  On  the  coast  of  Maine  the 
temperature  of  the  water  varies  from  55°  to  67°  F.  (12.8°-19.4° 
C),  and  the  season  is  from  July  1st  to  September  10th.  At  Cape 
May,  New  Jersey,  the  temperature  of  the  water  rises  from 
65°  F.  (18.3°  C),  June  1st,  to  80°  F.  (26.7°  C.)  in  early  Septem- 
ber. On  the  Atlantic  coast  there  are  variations  of  temperature 
according  to  the  wind — strong  southerly  winds  raise  the  tem- 
perature, while  "off  shore"  winds  lower  it. 

At  Atlantic  City  it  is  not  unusual  for  90,000  persons  to  enjoy 
sea-bathing  in  a  single  day.  On  Long  Island  Sound  the  tem- 
peratures are  higher  and  the  surf  less  than  on  the  sea-coast 
proper.  The  advantages  of  these  quieter  waters  for  the  young 
and  the  dclirate  are  obvious. 

Indications. — It  is  apparent  that  sea-bathing  must  be  con- 
sidered strictly  in  reference  to  local  conditions  before  it  is  ad- 
vised or  condemned  with  regard  to  a  particular  case.  It  might 
agree  with  a  person  at  Old  Point  Comfort  or  Cape  May,  and  be 
totally  unsuitable  on  the  coast  of  Maine.  The  daily  variation  in 
the  force  of  the  waves  and  the  presence  of  unusual  currents  are 
important  factors. 

For  the  strong  and  healthy  individual  the  sea-bath  is  usually 
exhilarating  and  refreshing.  The  best  time  for  bathing  is  in  the 
forenoon,  before  the  midday  meal ;  not  at  the  end  of  an  exhaust- 


SEA-BATHS 


379 


380 


HYDROTHERAPY 


ing  day  of  work;  not  before  breakfast  or  at  night;  never  directly 
after  eating.  Tliesc  simple  rules,  however,  are  constantly  vio- 
lated by  people  who  either  cannot  choose  their  bathing  hour 
or  indulge  in  two  or  three  baths  a  day.  The  shorter  the  summer 
vacation  the  greater  is  the  temptation  to  overindulgence.  In 
their  eagerness  to  make  the  best  of  their  time,  these  persons 
lounge  about  the  beach  in  salt-soaked  bathing  suits,  cover  them- 
selves with  sand,  go  in  again  and  repeat  the  process,  expecting 
to  toughen  themselves  by  the  most  unhygienic,  foolhardy,  and 
dangerous  practices.  The  ordinary  bath  of  ten  or  fifteen  minutes 
is  prolonged  to  hours. 


Ja*.    1  7*( 

r  MAjf     1  Am 

1  w 

f      f 

Amu       ITi 

If 

1 1 

F^ 

1      \  2 

tMt  .\th 

M      1 

Ml 

\tft^ 

1 

ilo 

1 

^^ 

— -*^^ 

j^' 

^ 

7« 

y 

^ 

^ 

^ 

N 

y/ 

X 

60 

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"^"^ 

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-ni 

1 

_ 

L.. 

.  _ 

Fig.  143. — Temperature  of  the  water  at  San  Diego,  California,  12  noon. 


Sea-bathing  is  useful  in  anemia  when  not  too  prolonged; 
in  torpor  of  the  liver;  in  neurasthenia  and  hypochondria  when 
not  associated  with  too  much  debility;  in  nervous  dyspepsia, 
chronic  constipation,  and  obesit}'. 

Reaction. — The  principal  safeguard  in  bathing  is  a  good 
and  prompt  reaction.  There  should  be  a  good  glow,  and  it 
should  be  maintained  by  active  exercise  in  the  water.  The 
body  should  be  completely  immersed ;  wading  in  shallow  water 
and  failure  to  wet  the  head  and  chest  produce  irregular  circula- 
tion. Reaction  is  delayed  in  the  weak  and  in  elderly  people, 
whose  skin  circulation  is  languid  and  whose  heart  action  is  poor; 
in  those  who  are  fatigued  or  overheated  before  bathing,  and  who 
are  not  accustomed  to  the  low  temperature  of  the  ordinary  sea- 
bath. 


SEA-BATHS  381 

Precautions. — Those  who  are  bathing  for  the  first  time  in 
the  season  should  be  cautious  and  moderate  until  they  are 
better  accustomed  to  it,  and  inexperienced  bathers  had  better 
avoid  emulating  the  feats  of  the  more  venturesome.  Muscular 
cramps  are  among  the  more  formidable  dangers  to  swimmers. 
They  usually  attack  the  leg  muscles  and  sometimes  the  trunk, 
and  quickly  render  the  swimmer  helpless.  They  are  generally 
due  to  overstrain,  and  come  on  without  warning  during  a  long 
swim;  they  may  occur  in  good  swimmers.  If  the  bather  can  be 
brought  to  shore  he  should  be  rubbed  vigorously,  dried,  and 
warmed. 

Colicky  pains  and  abdominal  spasms  may  follow  a  sea-bath 
taken  too  soon  after  eating.  Two  hours  after  a  meal  is  a  safe 
rule,  but  three  hours  is  better  if  digestion  be  likely  to  be  delayed. 
The  effects  of  a  sudden  shock  of  cold  water  before  digestion  is 
accomplished  are  best  met  with  heat  externally,  dry  rubbing, 
and  a  small  amount  of  tincture  of  ginger  and  water  or  a  little 
whisky. 

Aside  from  the  danger  of  being  carried  beyond  one's  depth 
by  unknown  currents,  or  the  common  danger  on  some  parts  of 
the  New  Jerse}^  coast  of  getting  into  channels  of  deep  water 
on  returning  shoreward,  a  rather  frequent  source  of  trouble, 
there  is  the  danger  of  remaining  in  the  bath  too  long  and  of 
failing  to  react  properly  afterward.  On  entering  the  water 
there  is  a  profound  impression  on  the  circulation.  The  tem- 
perature may  be  30  or  40  degrees  below  that  of  the  body,  and 
the  stimulus  to  the  nerve-centers  is  great.  The  superficial 
vessels  are  immediately  contracted,  and  the  abstraction  of  heat 
from  the  extensive  surface  calls  immediately  for  greater  heat- 
production.  The  momentary  shiver  on  entering  the  water 
should  promptly  give  place  to  warmth  and  a  sense  of  reaction. 

Counterindications. — When  the  skin  circulation  is  poor,  as 
it  commonly  is  in  those  inherently  feeble  or  weak  from  illness, 
or  in  those  of  advanced  years,  sea-bathing  should  be  avoided 
— at  least,  until  better  conditions  obtain.  In  any  case  of 
heart  disease,  great  care  should  be  exercised;  but,  as  is  well 


382  HYDROTHERAPY 

known,  cold  bathing,  when  properly  used,  tends  to  strengthen 
the  dilated  and  weakened  heart.  Persons  with  cardiac  lesions 
should  have  friends  or  attendants  near  and  take  no  risks.  No 
one  should  bathe  in  the  ocean  who  has  pulmonary  disease  or 
has  recentl}^  had  pneumonia,  pleurisy,  endocarditis,  peritonitis, 
appendicitis,  or  acute  Bright's  disease.  It  is  stated,  on  good 
authority,  that  sea-baths  increase  the  elimination  of  urea.  On 
that  account  we  might  suppose,  a  priori,  that  sea-bathing  at 
moderate  water  temperatures  would  be  beneficial  in  cases  of 
moderate  chronic  nephritis.  Care  should  be  exercised,  how- 
ever, that  the  body  should  not  be  exposed  to  cutting  winds. 
Women  should  not  bathe  during  the  menstrual  period.  Strange 
as  it  may  seem,  this  rule  is  occasionally  disregarded. 

Complete  innnersion  is  a  sine  qua  non  of  safety;  it  tends  to 
equahze  the  circulation  and  hasten  reaction.  Women  especiallj'', 
dislike  to  wet  their  heads,  as  it  takes  so  long  to  dry  their  hair; 
but  with  closely  fitting,  rubber  bathing-caps,  the  hair  may  be 
kept  dry  and  the  head  and  neck  arc  sufficiently  cooled.  Sea- 
bathing should  not  be  indulged  in  when  the  body  is  greatly 
overheated;  but  a  good  warmth  is  to  be  desired,  and  no  time 
lost,  so  as  to  get  chilled  by  strong  winds  before  going  into  the 
water.  The  chief  safeguard  in  the  water  is  to  keep  moving. 
A  tennis-ball  in  the  surf  promotes  activity  and  adds  to  the 
pleasure  of  the  bath.  Of  course,  no  one  should  bathe  shortly 
after  a  meal.  Two  hours  should  be  allowed  for  digestion.  One 
should  not  bathe  when  greatly  fatigued.  The  bath  in  the  quiet 
of  one's  house  will  be  safer  and  more  refreshing. 

The  writer  takes  about  75  ocean  baths  each  summer,  and 
has  rarely  seen  ill  effects  in  those  who  bathe  regularly.  Children 
who  go  in  and  out,  sun  themselves  on  the  sands,  and  return 
again  to  the  water,  sometimes  show  bad  effects;  but  most  young 
people  acquire  a  well-tanned  skin  in  summer,  and  become  so 
accustomed  to  sun  and  water  that  they  seem  to  bear  these  transi- 
tions with  wonderful  ease.  The  author  saw  a  case  of  appendici- 
tis in  a  boy  of  ten,  fever  and  pain  developing  on  the  evening 
of  the  day  on  which  he  had  bathed  in  the  surf.     Forty  hours 


COURSES    OF   INSTRUCTION   IN  HYDROTHERAPY  383 

after  the  bath  the  operation  disclosed  free  pus  in  the  abdominal 
cavity.  In  this  case,  which  fortunately  terminated  in  recovery, 
no  other  exciting  causes  could  be  assigned,  and  it  was  believed 
that  imprudent  batliing  had  brought  on  the  attack. 

Duration. — No  fixed  rule  can  be  made  as  to  the  proper  dura- 
tion of  an  ocean  bath.  This  will  vary  from  four  to  twenty 
minutes,  according  to  the  bather's  age,  physical  condition,  and 
the  temperature  of  the  water. 

COURSES  OF  INSTRUCTION  IN  HYDROTHERAPY 

Course  at  Colunibia  University. — This  college  has  the  honor 
of  having  established  the  first  chair  of  hydrotherapy  in  an 
American  medical  college.  This  chair  is  ably  filled  by  Dr. 
Simon  Baruch,  who  has  done  more  than  any  other  American  to 
bring  this  subject  to  the  serious  attention  of  the  medical  profes- 
sion. Since  1907  the  classes  at  Columbia  have  had  the  benefit 
of  his  teaching,  although  for  several  years  Dr.  Baruch  has  given 
instruction,  with  demonstrations,  at  the  New  York  Postgraduate 
Medical  School  and  Hospital.^ 

The  senior  class  is  divided  into  sections  of  ten  or  more,  who 
receive  chnical  instruction  in  the  hydrotherapeutic  department 
of  the  Vanderbilt  Clinic  on  Mondays  and  Fridays.  The  first 
half  of  the  clinic  is  devoted  to  demonstration  of  cases,  the 
diagnosis  is  briefly  dwelt  upon,  and  the  pathology  and  etiology 
are  referred  to  with  a  view  to  point  out  the  therapeutic  indica- 
tions. The  aid  of  hydriatric  measures  and  the  reason  for  their 
employment,  with  or  without  drugs,  in  the  concrete  case  are 
clearly  gone  into,  and  the  patient  is  treated  in  the  presence  of 
the  students,  who  are  encouraged  to  ask  explanations  of  any 
obscure  point.  The  latter  half  of  the  clinic  is  devoted  to  de- 
monstration of  the  technic  of  hydriatric  procedures,  and  stu- 
dents are  requested  to  practice  them,  just  as  they  are  taught 
bandaging  or  other  manual  procedures  in  other  clinics.  The 
clinic  is  under  the  charge  of  a  chief  and  two  assistants  and  an 

1  See  introductory  lecture  to  the  course  on  Hydrotherapy  in  the  College 
of  Physicians  and  Surgeons,  Columbia  Univ.  Med.  Rec,  Feb,  27,  1909. 


384  HYDROTHERAPY 

attendant,  who  treat  cases  under  their  direction  on  Mondays, 
Wednesdays,  and  Fridays  from  1  to  4  p.  m.  Only  males 
arc  treated  for  obvious  reasons.  Female  patients  and  cases 
not  required  forteacliing  are  referred  to  the  Riverside  Associa- 
tion Hydriatric  Department,  which  is  under  my  tlirection,  and 
treats  about  50  cases  daily.  Wednesday  afternoon  is  devoted 
to  experiments  in  hydrotherapy.  A  course  of  lectures  during 
the  latter  half  of  the  semester  is  also  provided  upon  the  principles 
of  hydrotherapy  and  their  practical  application  in  disease.  The 
final  examination  contains  not  less  than  two  questions  on  hydro- 
therapy. 

The  members  of  the  class  also  have  access  to  Dr.  Wittson's 
wards  in  the  J.  Hood  Wright  Memorial  Hospital,  where  hydro- 
therapy is  practised  in  suitable  cases. 

Course  at  the  Chicago  Institute  of  Physiologic  Therapeutics. — 
Dr.  William  S.  Sadler's  ^  plan  of  instruction  in  hydrotherapy 
provides  for  the  following  course : 

Nerve  training,  or  a  graded  system  of  thermic,  electric,  and 
hydriatric  applications. 

Muscle  training,  or  graduated  exercises,  from  the  Schott 
system  to  the  heavy  manual  Swedish  movements. 

Cardiovascular  training,  beginning  with  the  Nauheim  regime 
and  embracing  graded  hydriatric  and  massage  measures,  con- 
stituting a  systematic  course  of  vasomotor  gjaimastics. 

Visceral  training,  consisting  of  special  douches,  massage,  and 
phototherapy,  for  congested  or  anemic  viscera. 

Skin  training,  or  a  graduated  system  of  hydrotherapy,  for 
the  debilitated  and  inactive  skin. 

Tonic  regime  for  neurasthenia  and  other  nervous  disorders. 

Courses  in  Europe. — In  Wiirzburg,  Prof.  Geigel  gives  a  course 
in  balneotherapy. 

In  Jena,  Prof.  Kionka  teaches  balneotherapy  during  the 
summer  session,  and  Prof.  Matthes  teaches  hydrotherapy  in 

^  Dr.  Sadler  also  has  a  clinic  for  hydrotherapy,  electricity,  massage,  photo- 
therapy, etc.,  at  the  Post-Graduate  Medical  School,  2400  Dearborn  Street, 
Chicago. 


COURSES   OF   INSTRUCTION   IN   HYDROTHERAPY  385 

connection  with  clinical  medicine.  In  Leipzig,  Prof.  Wind- 
scheid;   in  Halle,  Profs.  A.  Schmidt  and  W.  Winternitz. 

In  Berlin,  Prof.  Brieger  is  in  charge  of  the  new  Institute  for 
Hydrotherapy,  which  subject  he  teaches  practically  and  ably, 
assisted  by  Drs.  Krebs,  Lacquer,  and  Machant.  At  present 
chnical  lectures  are  delivered  with  demonstrations  on  four  days 
each  week,  11  to  12  a.  m.  Prof.  Frankenhauser  gives  instruction 
in  balneotherapy.  Prof.  Curschman,  in  Leipzig,  has  an  institute 
for  physical  therapeutics;  there  is  also  an  excellent  hydrothera- 
peutic  institute,  in  Rome,  on  the  via  Plinio.  Prof.  Lechtheim 
teaches  hydrotherapy  at  Konigsberg;  Prof.  Schulz,  at  Greifs- 
wald;  Prof.  Ercklentz,  at  Breslau. 

A  remarkable  improvement  in  hydrotherapeutic  facilities  has 
been  recently  noted  throughout  Europe,  and  crude  apparatus  is 
being  rapidly  supplanted  by  the  best  to  be  found  anywhere. 

Dr.  J.  H.  Pratt,  of  Boston,  was  m^uch  impressed  with  this 
fact,  and  states  that  it  is  less  than  ten  years  ago  that  Munich 
had  the  only  well-equipped  department  of  physical  therapeutics 
in  Germany,  and  before  it  was  opened  Dr.  Baruch  did  not  find 
a  single  clinic  in  that  country  with  a  good  hydrotherapeutic 
douche  table.  Now  all  this  is  changed.  In  the  small  city  of 
Heidelberg,  for  example,  there  is  an  institute  for  physical  therapy 
connected  with  the  university  polyclinic,  which,  in  the  character 
and  excellence  of  its  equipment,  is  unequalled  by  any  in  the 
United  States.  What  is  of  equal  importance  is  the  careful 
medical  supervision  of  treatment.  This  is  under  the  direction 
of  Prof.  Hammer,  who  is  assisted  by  8  trained  operators  and 
masseurs.  This  institute  for  physical  therapy  occupies  over 
half  of  the  new  building  of  the  medical  polycHnic,  which  was 
erected  in  1906  at  a  cost  of  $40,000.  The  growth  of  scientific 
hydrotherapy  has  created  a  demand  for  better  apparatus.  As 
a  result,  the  best  hydrotherapeutic  apphances,  including  the 
best  douche  tables  obtainable  to-day,  are  made  in  Germany, 
although,  as  stated  above,  it  is  only  a  few  years  ago  that  Dr. 
Baruch  called  attention  to  the  lack  of  proper  hydrotherapeutic 
facilities  throughout  that  country. 

25 


386  HYDROTHERAPY 

In  the  medical  clinic  of  Prof.  Krehl  in  Heidelberg  there  is 
another  complete  hydrotherapeutic  ecjuipment  for  the  treatment 
of  in-patients,  A  department  for  moehanothcrapy  is  maintained 
by  Prof.  Vulpius  in  connection  with  the  orthopedic  clinic.  In 
addition  there  is  a  large  and  attractive  "Halle-Bad,"  which  is 
owned  by  the  City  of  Heidelberg.  The  new  and  expensive 
buildings  contain  not  only  shower  and  swimming  baths,  but 
are  equipped  also  with  apparatus  for  electric-light  and  carbon- 
dioxid  baths. 

In  Tubingen  a  douche  apparatus  has  been  recently  installed.' 

ACCIDENTS  IN  HYDROTHERAPY 

The  chief  dangers  are  from  falls  upon  shppery  places  in  the 
bath-room  or  douche-room;  from  vertigo  or  faintness  in  getting 
in  or  out  of  the  tub,  and  from  epileptic  or  other  convulsions. 
The  author  has  a  remarkable  collection  of  such  accounts,  taken 
from  the  pubHc  press.  Baths  given  for  medical  purposes  need 
much  more  supervision  than  baths  for  ordinary  purposes,  as  the 
person  bathing  may  be  weaker  or  have  some  cardiac  or  cerebral 
trouble  which  the  heated  air  of  the  bath-room  or  the  confine- 
ment and  heat  of  the  pack  accentuate.  Recently  the  public 
press  reported  the  death  by  drowning  in  his  own  bath-tub  of  a 
man  whose  head  had  slipped  below  the  water  in  a  faint.  Hence, 
an  attendant  should  be  at  hand,  and  the  patient  should  never 
be  left  unguarded. 

Drowning  accidents  due  to  epilepsy  have  happened  in  tubs 
and  swimming  pools.  Patients  have  been  burned  or  scalded  by 
hot  applications  made  while  unconscious  (see  p.  181). 

Claims  for  damages  are  occasionally  demanded  by  patients, 
so  that  a  recent  case  in  Paris  has  excited  a  good  deal  of  atten- 
tion. A  medical  man.  Dr.  Cormon,  had  been  called  in  to  at- 
tend a  young  woman,  Mile.  Peyronnette,  suffering  from  appen- 
dicitis, and  as  the  result  of  his  treatment  by  ice-bags  an  eschar 
had  formed,  and  50,000  francs  damages  were  claimed.  Dr. 
Balthazard,  the  medical  expert,  who  had  been  chosen  by  the 

^  International  Clinics,  eighteenth  series,  vol.  iv,  1908. 


ACCIDENTS   IN  HYDROTHERAPY  387 

court  to  give  his  opinion,  had  been  rather  severe  in  his  first 
report,  but  when  the  trial  came  on  he  was  much  less  so,  and 
he  found  arrayed  against  him  the  whole  faculty,  who  one  and 
all  considered  the  eschar  an  accident  which  in  nowise  could  be 
foreseen.  Dr.  Cormon  had  been  accused  of  not  using  a  piece  of 
flannel  cloth  as  a  protection,  but  he  argued  it  was  the  practice 
of  many  surgeons  to  apply  the  ice-bag  directly  on  the  skin. 
The  prosecution  found  that  it  could  not  attack  Dr.  Cormon  on 
this  count,  so  it  accused  him  of  having  failed  to  see  the  symp- 
toms indicating  the  advent  of  an  eschar.  Dr.  Cormon  answered 
that  he  had  foreseen  them,  and  had  then  had  the  ice  removed. 
Dr.  Jalagnia  and  Prof.  Dieulafoy  declared  that  there  was  no 
exact  limit  as  to  the  amount  of  time  during  which  ice  should 
be  used  on  the  abdomen,  and  as  for  the  eschar,  it  sometimes  ap- 
pears with  the  greatest  rapidity.  The  testimony  showed  that 
Dr.  Cormon  had  not  taken  the  temperature  of  the  patient,  which 
was  another  fault  of  which  he  was  accused.  Dr.  Triboulet,  who 
succeeded  to  Dr.  Cormon  in  the  treatment  of  the  patient,  said 
he  had  very  few  changes  to  make  in  what  was  done.  Judgment 
was  given  as  usual  a  week  after  the  calling  of  the  witnesses,  and 
Dr.  Cormon  was  acquitted.^ 

Paralytics  have  been  scalded  to  death  by  careless  attendants. 
In  a  recent  case  the  nurse  turned  on  the  hot  and  cold  water 
together  while  a  paralytic  was  bathing.  While  the  nurse  was 
absent  the  hot  water  caused  fatal  injuries. 

^  Therapeutic  Gazette,  1907,  p.  747. 


CROUNOTHERAPY';    CRENOLOGY^;    OR    THE 
USE   OF  MINERAL  WATERS    INTERNALLY 

The  vast  extent  to  which  mineral  waters  are  used  internally 
is  remarkable.  In  the  United  States  over  56,000,000  gallons 
of  natural  American  mineral  waters,  from  600  springs,  are  sold 
annually  at  a  valuation  of  about  §7,300,000.  The  importations 
of  natural  mineral  waters  reach  about  3,000,000  gallons,  and  are 
valued  at  SI, 033,000.^  To  what  extent  waters  are  sold  and  con- 
sumed in  Great  Britain  and  the  continent  of  Europe  is  unknown, 
but  it  is  known  that  30,000  visitors  visited  Carlsbad  in  1906, 
of  whom  2000  were  Americans.  The  number  of  annual  visitors 
at  Nauhcim  is  also  about  30,000.  At  Baden-Baden  they  number 
over  100,000  annually.  Of  com'se  they  drank  the  waters  as  well 
as  bathed  in  them.* 

In  the  United  States  there  are  about  2800  spring  localities 
and  nearly  9000  individual  springs.  In  the  Yellowstone  Park 
there  are  2000  springs  and  100  geysers.  With  this  wealth  of 
mineral  water  in  the  United  States,  we  naturally  wish  to  make 
an  approximate  comparison  of  our  own  springs  with  those  of 
Europe.  From  an  analytic  standpoint  this  may  be  attempted, 
but  in  point  of  equipment,  regime,  and  scientific  appUcation 
of  the  waters,  America  is  far  behind  the  European  system, 
although  fair  attempts  are  made  in  a  few  American  resorts  to 

1  Term  suggested  by  David  Riesman,  Cohen's  System  of  Physiologic  Thera- 
peutics, vol.  ix. 

2  Term  suggested  by  Leonard  Williams,  The  Clinical  Journal,  London,  Feb- 
ruary 3,  1904. 

^See  The  Production  of  Mineral  Waters  in  190S,  by  Samuel  Sanford, 
Wasliington,  D.  C,  Government  Printing  Office,  1909.  Dept.  of  tlie  Interior, 
U.  S.  Geological  Survey. 

*  It  has  been   calculated  that  upward  of  200,000,000  gallons  of  aerated 
waters  are  consumed  in  Great  Britain  and  Ireland  per  annum  (Hutchins^on). 
These  waters  were  invented  by  the  distinguished  chemist,  Joseph  Priestley,  in 
the  latter  half  of  the  eighteenth  century. 
388 


CEOUNOTHERAPY ;  CRENOLOGY  389 

carry  on  the  principles  of  hydrotherapy  successfully.  In  Europe 
the  springs  are  generally  owned  and  controlled  by  the  local  or 
national  governments,  which  have  spent  large  sums  in  permanent 
improvements,  including  imposing  buildings,  adequate  apparatus, 
and  all  the  accessories  that  make  the  visitor's  stay  agreeable  as 
well  as  beneficial.  There  are  strict  regulations  and  usually  a 
small  tax  is  imposed,  according  to  the  length  of  stay,  the  pro- 
ceeds being  apphed  toward  permanent  improvements. 

In  America  there  is  no  State  regulation,  excepting  at  the 
900-acre  reservation  at  Hot  Springs,  Arkansas,  and  in  the  Yel- 
lowstone National  Park,  where  the  United  States  Government 
owns  the  ground  and  exercises  strict  control  over  the  use  of  the 
water  and  fixes  the  schedule  of  charges.  Private  corporations 
control  the  best  resorts  in  this  coimtry,  and,  as  a  rule,  they 
are  ahve  to  their  own  interests  and  jealous  of  the  reputation 
of  their  particular  springs.  But  the  chief  criticism  under  this 
arrangement  will  always  be  that  ''to  him  that  hath  shall  be 
given,"  but  to  him  that  hath  not  little  attention  is  paid.  The 
expense  of  hydrotherapy  is  very  great,  although  more  is  being 
done  for  the  poor  of  our  cities  than  formerly.  It  is  to  be  hoped 
that,  as  the  wisdom  and  the  feasibility  of  giving  the  fresh  open- 
air  treatment  to  the  poor  consumptives  is  being  learned,  the 
state  or  national  government  will  eventually  take  up  the  cor- 
responding charity  of  giving  to  the  poor  rheumatic,  or  otherwise 
disabled  citizen,  the  benefits  of  our  hot  springs  or  other  waters 
so  liberally  provided  by  nature. 

The  United  States  Government  has  equipped  hospitals  at 
Hot  Springs,  Arkansas,  for  the  officers  and  enlisted  men  in  both 
branches  of  its  military  and  naval  service,  and  also  a  free  govern- 
ment bath-house  for  indigent  sufferers.  The  Yellowstone  Na- 
tional Park  awaits  development  in  this  respect,  and  for  a  por- 
tion of  the  year  could  no  doubt  be  utilized.  The  State  of  New 
York  has  recently  appropriated  one  million  dollars  toward  ac- 
quiring the  famous  springs  of  Saratoga,  so  that  the  famous 
resort,  with  its  valuable  springs,  may  be  developed  and  main- 
tained as  a  State  property,  free  from  objectionable  features, 
and  available  for  the  people  of  every  class. 


390 


HYDROTHERAPY 


CLASSIFICATION  OF  MINERAL  WATERS 

The  following  classification  by  Dr.  A.  C.  Peale,  of  Washington, 
is  the  most  practical.'  It  gives  at  once  a  definite  idea  of  the 
general  chemical  composition  and  other  characteristics: 


Group. 


A.  Thermal. 


B.  Non-thermal . 


Class. 
f        I.  Alkaline. 

r  Sulphated, 
II.  Alkaline-saline.    <   Muriatcd, 
[^  Borated. 

{Sulphated, 
Muriated, 
Borated. 


IV.  Acid. 


[   Sulphated, 
'   Muriated, 

Silicious /    Sulphated, 

I    Muriated. 


1.  Sodic 

2.  Lithic 

3.  Potassic 

4.  Calcic 

5.  Magnesic 

6.  Chalybeate 

7.  Aluminous 


} 


Non-gaseous. 
Carbonated  COj. 
Sulphurated  H.,S. 

Azotized  N. 
Carburated. 
Oxygenated  O. 


RADIO-ACTIVITY   OF  MINERAL    WATERS 

Waters  containing  a  comparatively  small  amount  of  mineral 
constituents  have  been  claimed  to  have  a  therapeutic  value 
which  the  ordinary  chemic  analysis  fails,  as  a  rule,  to  explain 
in  any  adequate  manner.  It  is  barely  possible  that  the  recent 
discovery  of  radio-active  properties  in  some  of  these  waters 
may  afford  some  explanation  of  these  qualities.  Some  of  the 
thermal  springs  of  Europe,  such  as  Baden  near  Vienna,  Bad 
Gastein,  Joachimstal  near  Prague,  Luchon,  Plombieres,  Dax, 
La  Bourboule,  Aix-les-Bains,  and  Buxton,  England,  have  been 


*  See  Transactions  of  the  American  Climatological  Association,  1887,  p. 


156. 


RADIO-ACTIVrrY    OF   MINERAL    WATERS  391 

tested  in  this  respect,  and  have  been  found  to  contain  slightly 
varying  quantities  of  argon  and  helium  with  distinct  radio- 
active properties,  these  elements  showing  a  constant  association 
with  waters  of  this  class.  The  suggestion  has  been  offered  that 
this  fact  throws  some  light  on  one  of  the  problems  of  the  chemistry 
of  mineral  waters,  namely,  why  a  natural  mineral  water  should 
have  distinctly  greater  therapeutic  power  than  a  water  to  which 
is  given  artificially  precisely  similar  chemic  constituents  accord- 
ing to  a  standard  analysis. 

Mineral-water  baths  afford  a  great  opportunity  for  charla- 
tanry. Claims  are  made  regarding  an  electric  action  in  the 
bath,  and  the  mysterious  quality  of  radio-activity  has  lately 
been  brought  forward,  reaching  England  and  America,  in  ex- 
plaining the  efficacy  of  various  mineral  springs.  W.  R.  Huggard 
says,  ''There  is  not  a  particle  of  scientific  evidence  to  warrant 
the  belief  in  any  greater  electric  action  in  the  mineral  baths  at 
spas  than  in  baths  taken  quietly  in  one's  own  room.  The  radio- 
activity of  mineral  waters  now  occupies  much  attention,  but,  up 
to  the  present,  we  have  only  speculations  as  to  its  therapeutic 
influence."  ^ 


1  The  following  letter,  from  Prof.  Wolcott,  was  received  by  the  author  in 
response  to  an  inquiry  as  to'  the  radio-activity  of  waters  in  Colorado : 

Colorado  School  of  Mines,  Golden,  Colo.,  Jan.  3,  1906. 
Dear  Sir: 

In  regard  to  the  mineral  waters  of  Colorado,  I  have  examined  the  waters 
at  Glenwood  Springs  and  at  Manitou  and  found  them  radio-active.  I  have 
examined  also  several  samples  sent  in,  but  found  none  of  them  radio-active. 
The  water  from  Clear  Creek,  which  flows  through  this  city  and  which  drains 
the  region  near  Central  City  where  the  Pitchblende  mine  is  located,  is  radio- 
active and  the  time  of  decay  corresponds  to  that  of  the  radium  emanation. 
We  are  at  present  working  along  this  line  and  the  results  have  not  as  yet  been 
published.  Very  truly  yours, 

E.  R.  Wolcott. 


Prof.  Boltwood,  of  Yale,  was  commissioned  by  the  U.  S.  Government 
to  examine  the  waters  of  Hot  Springs,  Arkansas,  and  reported  them  all  radio- 
active. This  is  due  to  a  dissolved  radium  emanation,  a  gas,  and  not  the 
presence  of  salts  of  radium  or  other  radio-active  substances. 


392      '  HYDROTHERAPY 

"  Another  antiquated  notion  is  that  the  solid  constituents  of 
the  baths  are  absorbed  through  the  skin.  The  evidence  is  now 
overwhehning  that  through  the  unbroken  skin  there  is  no  absorp- 
tion except  for  gases,  volatile  substances,  and  substances  in- 
corporated with  some  fatty  agent  which  can  be  rubbed  in. 
Iron,  even  if  present  in  tenfold  the  amount  found  in  mineral 
waters,  would,  when  applied  externally,  be  quite  incapable  of 
acting  on  the  blood."  '■ 

The  following  is  a  partial  statement  of  the  radio-activity  of 
various  European  springs,  according  to  the  authors  quoted : 

Radio-activity  in  milligram 
minutes  (10  liters  of  gas). 

Bad  Ga.stein,  Austria,  Gratenbacker 79.20 

Bagncres-dc-Luchon,  France,  Borden 18.36 

Source,  Borden,  No.  2 14.43 

Pre,  No.  1 10.23 

"       Saule,  No.  2 9.42 

"  "         "  "       Fcrras  enceinte 4.19 

Plombi^res,   Source,  Vauquelin 14.90 

Galerie  de  Thalweg 13.60 

"  Les  Capucins 4.62 

Aix-les-Bains,  France 3.52 

Dax,  France,  Source,  Trou-des-Pauvres 2.92 

Bagn6res-de-Bigorre,  France,  Source,  Salies 2.32 

La  Bourboules,  France  ("\Vater.«) 3.56 

Bagneres-de-Luchon  "       2.20 

Aix-les-Bains  "       54 

Mm.  Curie  and  Laborde,  Mm.  Ch.  Moureu,  and  A.  Lepape 
and  A.  Brochet  have  made  a  systematic  study  of  the  radio- 
activity of  some  French  springs.  The  observations  are  reduced 
to  a  standard  of  "milligram-minutes "  for  10  liters  of  gas  emanat- 
ing from  the  spring  tested,  and  also  for  10  liters  of  the  water. 
The  standards  of  measurement  were  first  prepared  by  Mm. 
Cheneveau  and  Laborde,-  and  are  detailed  by  ]\Im.  Ch.  Mouren 
and  Adolphe  Lepape  in  Bulletin  de  I'Acad^mie  de  Medecine, 
1909,  No.  13. 

Mouren  and  Lepape  spent  six  months  at  Bagneres-de-Luchon 

*  Handbook  of  Climatic  Treatment,  London,  1906. 

2  Journal  de  Physique,  1908,  3d  fascicule,  p.  262.  For  the  radio-activity 
of  the  waters  of  Baden-Baden,  .see  The  Brit.  Med.  Jour.,  April  23, 1910,  p.  1004. 


RADIO-ACTIVITY    OF   MINERAL   WATERS  393 

with  Mm.  les  Drs.  Ferras  and  Estradere  in  the  study  of  twenty 
separate  springs.  They  noted  that  the  emanation  of  radium 
from  the  gas'  which  they  tested  diminished  gradually  and  spon- 
taneously after  collection,  so  that  after  about  four  days  only 
about  one-half  of  the  radio-activity  remained,  corresponding  in 
this  respect  with  M.  and  Mme.  Curie's  statement. 

The  Joachimsthal  Baths. — Ever  since  the  examinations,  con- 
ducted by  competent  scientists,  of  the  nature  of  the  therapeutic 
action  exercised  by  the  Gastein  waters  have  shown  that  the 
main  source  of  the  beneficent  quality  is  the  presence  of  radium 
emanation,  experiments  have  been  going  on  in  the  place  where 
the  greatest  quantities  of  pitchblend  and  radium  salts  are  found, 
in  Joachimsthal  near  Prague,  to  ascertain  whether  the  waters 
found  in  these  mines  could  not  be  used  for  medical  purposes. 
At  the  clinic  of  Prof  Neusser  of  Vienna,  a  large  number  of 
patients  have  been  subjected  to  a  treatment  with  these  waters. 
Patients  with  gout,  rheumatism,  neuritis,  and  diabetes  have 
been  benefited  by  the  internal  and  external  use  of  Joachimsthal 
mine  water.  It  has  been  found  that  there  are  two  distinct 
groups  of  waters  to  be  obtained  therefrom.  The  weaker  water, 
containing  from  8000  to  10,000  volts  of  emanation,  was  derived 
from  the  underground  springs  and  brooks,  which  are  constantly 
flowing  in  the  deeper  shafts,  and  have  to  be  pumped  away  to 
keep  the  mine  workable.  The  stronger  water  was  obtained  from 
the  refuse  of  the  mining  process,  wliich  combines  various  chemic 
processes,  and  in  its  last  step  requires  the  washing  of  the  material 
by  sulphuric  acid.  The  ultimate  results  are  uranium  (used  for 
coloring  purposes)  and  a  water  charged  with  radium  emanation 
in  a  high  degree,  so  that  it  excels  the  Gastein  waters  three  or  four 
times  in  its  voltage.  These  latter  waters  have  been  used  also 
for  prostatic  enlargement  with  remarkable  success.  The  baths 
have  shown  themselves  so  active  that  general  symptoms  (due  to 
destruction  of  leukocytes)  may  appear  after  incautious  use.  In 
Joachimsthal  itself,  a  bathing  house  with  at  present  only  twelve 
cabins  has  been  established  for  radium  baths.  In  a  similar  way 
the  hot  sulphur  baths  of  Baden,  near  Vienna,  have  been  tested 


394  HYDROTHERAPY 

and  the  presence  of  radium  emanation,  though  in  a  lower  degree, 
was  detected.  The  experiments  tend  to  show  that  the  i)resence 
of  the  active  principle  is  in  an  inverse  ratio  to  the  temperature 
of  the  water.  The  sulphur  nmd  deposited  at  the  hot  springs 
in  this  place  contains  radium  bromid,  so  that  it  affects  the 
photographic  plate.  This  explains  why,  for  instance,  inveterate 
cases  of  skin  disease  respond  so  readily  to  the  mud  baths  at 
Baden,  although  they  are  refractory  to  water  baths  and  oint- 
ment even  in  Aachen  or  other  hot  suli)hur  baths.  It  is  planned 
now  to  institute  special  radio-active  sulphur  baths  in  this  place, 
and  it  will  be  the  first  health  resort  of  its  kind  which  can  boast 
both  of  the  vicinity  of  the  capital  and  of  the  radio-activity. 

Artificial  Radio-active  Waters.— Attempts  have  been  made 
to  produce  radio-active  water  by  artificial  methods  for  thera- 
peutic purposes.  Dr.  William  J.  Morton  uses  a  water  rendered 
radio-active  by  immersing  from  50  to  100  pounds  of  a  high-grade 
pitchblend  in  a  vessel  of  water,  and  has  found  that  the  measure 
of  radio-activity  of  the  water  is  about  one-tenth  to  one-half  that 
of  metallic  uranium.  The  rate  of  decay  of  the  radio-activity, 
however,  was  very  rapid,  falling  to  one-half  in  a  few  hours,  and 
no  trace  remaining  after  a  few  days. 

Dr.  John  B.  Shober,  of  Philadelphia,  following  a  suggestion 
of  Prof.  E.  Rutherford,  of  London,  has  used  purified  cocoanut 
charcoal,  and  succeeded  in  raising  the  water  so  treated  to  one 
hundred  and  sixty  times  the  radio-activity  of  uranium  oxid. 
His  conclusions  are  that  the  beneficial  effects  of  radio-active 
spring  waters,  and  the  results  obtained  abroad  by  the  administra- 
tion of  weak  emanation  preparations,  warrant  the  belief  that  in 
the  highly  radio-active  charcoal  we  have  an  agent  that  will  be 
followed  by  the  same,  if  not  better,  results.^ 

The  waters  of  Kreuznach  have  been  used  extensively  for  a 
long  time  for  bathing,  and  of  late  a  good  deal  of  stress  has  been 
laid  on  the  radio-activity  of  these  waters  as  a  factor  in  the 
cure.     Englemann  attributes  great  value  to  the  well-known 

1  Jour.  Amer.  Med.  Assoc,  Aug.  21,  1909,  pp.  624-628;  see  also  Nagel- 
schmidt,  Berliner  Klin.  Woch.,  March  16,  1908. 


HOT-WATER   DRAUGHTS  395 

rich  radium  emanations  of  the  water  and  the  sediment.  He 
has  recently^  reported  on  the  results  obtained  in  234  patients, 
who  took  2595  baths,  the  principal  indications  being  rheuma- 
tism, sciatica  and  other  neuralgias,  gout,  and  for  the  resorption 
of  pelvic  exudates.     The  results  were  considered  favorable. 

Other  springs,  as  those  of  Postyen  (Pistyan),  in  Austria,  are 
also  coming  into  favor  in  the  same  manner,  having  a  fair  degree 
of  radio-activity. 

INTERNAL  USE  OF  WATER  IN  HEALTH 

The  healthy  adult  requires,  according  to  his  weight,  from 
1  to  2  quarts  of  water  daily,  independent  of  the  water  contained 
in  food.  The  labor  of  transferring  this  amount  to  the  excre- 
tory organs — the  kidneys,  lungs,  bowels,  and  skin — falls  on 
the  heart.  The  circulation,  glandular  secretions,  peristalsis,  and 
metabolism  are  distinctly  influenced.  Water  is  not  absorbed 
to  any  very  great  extent  by  the  stomach,  but  by  the  bowels, 
and  hence  as  much  good  or  more  can  be  accomplished  by  en- 
teroclysis  as  by  administration  of  water  by  the  mouth. 

Regarding  metabolic  changes  produced  by  water  drinking, 
it  must  be  recognized  that  for  a  short  time,  at  least,  nitrogenous 
products  are  washed  out,  but  it  has  been  shown  that  pure  water 
has  no  effect  on  the  sphtting  up  of  albumins  and  on  the  general 
metaboHsm  (Rubner). 

Schoendorff  and  other  authorities  believe  that  water  drinking 
has  very  little  practical  effect  on  the  excretion  of  uric  acid. 

HOT-WATER   DRAUGHTS 

Hot-water  drinking  is  not  so  much  in  vogue  as  it  was  ten  or 
fifteen  years  ago,  probably  on  account  of  the  tendency  to  undue 
relaxation  of  the  gastro-intestinal  tract  when  continued  for 
long  periods.  In  small  quantities  hot  water  raises  the  pulse- 
rate  and  lowers  the  blood-pressure.  After  twenty  minutes  the 
usual  rate  and  pressure  are  restored. 

1  Medizinische  Klinik,  May  30,  1909,  No.  22. 


396  HYDROTHERAPY 

Natural  Thermal  Waters. — The  principles  applying  to  the  use 
of  hot-  or  warm-water  draughts  are  equally  applicable  to  the 
weaker  natural  thermal  waters.  These  are  indicated  in  hyper- 
chlorhydria,  gastrorrhea,  and  gastralgia;  acute,  suppurative, 
and  interstitial  nephritis.  In  the  latter  affection  there  are  favor- 
able reports  from  the  judicious  use  of  water,  in  connection  with 
hot  applications  to  the  back  and  abdomen.  The  author  is  more 
inclined  to  the  moderate  use  of  water  in  nephritis  than  in  his 
earlier  practice. 

Hot-water  draughts  are  counterindicated  in  disease  of  the 
heart  with  failure  of  compensation.  In  this  class  of  cases  it  is 
best  to  restrict  the  total  quantity  of  water  consumed  to  about 
1200  cc,  independent  of  the  water  contained  in  the  food.  In 
administering  water  to  promote  diuresis,  it  must  always  be 
borne  in  mind  that  we  have  to  look  to  the  heart  for  the  vis  a  tergo: 
while  there  is  low  pressure  in  the  kidneys  there  can  never  be 
satisfactory  diuresis. 

The  weaker  natural  waters  are  usually  more  acceptable  to 
the  stomach  by  reason  of  large  gaseous  contents  at  their  source. 
Artificial  heat  applied  to  ordinary  tap-water  drives  off  the 
carbonic  acid  gas  and  oxygen,  which  are  largely  present  in  most 
thermal  springs. 

Hot  springs  are  found  in  Virginia,  Arkansas,  California, 
Colorado,  New  Mexico,  and  South  Dakota.  In  Europe,  those 
of  Aix-la-Chapelle,  Baden-Baden,  Ems,  Carlsbad,  Wiesbaden, 
Gastein,  Bath,  and  AJK-les-Bains  are  the  most  famous. 

COLD-WATER  DRAUGHTS 

These  are  indicated  in  febrile  states  and  in  hypochlorhydria. 
The  most  favorable  time  for  use  is  thirty  to  forty  minutes  before 
meals.  Cool  water  should  be  used  freely  before  and  during 
the  hot  bath,  and  given  abundantly  in  typhoid  fever.  In  some 
hospitals  a  special  nurse  is  assigned  to  give  water  to  the  patients. 

Cold  water  is  counterindicated  in  gastric  dilatation,  gas- 
troptosis,  colic,  in  cases  with  a  weak  myocardium,  and  in  all 
states  of  fatigue  and  when  perspiration  is  free.     Ice-water  is 


DISTILLED   WATER  397 

particularly  dangerous  at  these  times,  although  the  temptation 
is  very  great  to  quench  thirst.  In  most  cases  the  free  use  of 
water  during  meals  is  not  advisable.  It  is  believed  to  delay 
the  digestion  of  starchy  and  other  foods.  Individuals,  however, 
vary  greatly  in  this  respect,  and  many  are  accustomed  to  drink 
3  or  4  glasses  of  water  during  meals  with  entire  impunity. 
The  author  believes  that  a  moderate  amount  of  cool  water — 
1  glassful — is  not,  as  a  rule,  injurious.  Patients  who  must 
avoid  starchy  foods,  and  who  eat  freely  of  meat,  are  no  doubt 
benefited  by  the  free  use  of  pure  water  before  and  after  meals. 
Most  people  drink  too  little,  and  this  is  particularly  the  case 
with  women,  and  very  often  leads  to  constipation,  acid,  dense 
urine,  and  occasionally  to  irritability  of  the  bladder  accompany- 
ing urine  of  high  specific  gravity.  Many  stomachs  are  ruined 
by  an  attempt  to  flush  the  system  with  large  quantities  of  water, 
and  hence  it  is  a  rule  to  avoid  large  quantities  of  water  or  liquid 
food  in  cases  of  gastroptosis,  etc.  (see  p.  150  et  seq.). 

DISTILLED  WATER 

This  is  a  chemically  pure  water,  made  palatable  by  the  addi- 
tion of  oxygen,  with  or  without  carbonic  acid  gas.  Much  discus- 
sion has  arisen  as  to  the  propriety  of  using  a  water  without  any 
solid  constituents,  the  claim  having  been  made  that  its  use 
tends  to  abstract  valuable  salts  from  the  system.  These  objec- 
tions are  more  theoretic  than  practical,  the  rather  extensive 
use  of  distilled  water  on  shipboard  and  elsewhere  not  having 
been  attended  by  any  bad  results.  Oxygenated  and  carbonated 
distilled  water  is  ^ddely  sold  under  various  trade  names  in 
syphons.  It  is  much  more  palatable  than  the  distilled  water 
of  the  chemic  laboratory  and  more  economical. 

Distilled  water  can  be  easily  and  cheaply  produced  for 
household  use  by  means  of  a  still  heated  by  gas  or  oil.  A  satis- 
factory apparatus,  shown  in  Fig.  144,  is  known  as  the  Par- 
melee  Automatic  Aerating  Water  Still  and  Sterilizer.  If  oil  be 
used  to  heat  it,  a  blue-flame  Primus  or  Khotal  oil-stove  should 
be  employed. 


398 


HYDROTHERAPY 


Distilled  water  is  no  doubt  an  ideal  drinking-water,  far  pref- 
erable to  the  mineralized  waters  for  constant  use.  In  regions 
where  limestone  formations  and  alkaline  deposits  characterize 
the  soil,  the  use  of  distilled  water  would  prevent  the  disturbance 
of  the  stomach  and  bowels  commonly  observed.* 

Dr.  G.  Bullot,  of  the  Universit}'  of  California,  has  recently 
carried  on  some  experiments  with  fresh-water  crustaceans, 
finding  that  they  die  promptly  when  placed  in  distilled  water. 


External  view. 


Sectional  view. 


Fig.  144. — The  Parmclee  still  (Ashton). 


It  is  the  author's  belief,  however,  that  oxygenated  distilled 
water  for  drinking  purposes  is  not  injurious. 

Marcuse  noted  the  total  amount  of  urine  voided  by  a  patient 
aged  thirty-five  who,  for  five  years,  had  had  chronic  parenchy- 
matous nephritis.  This  patient  for  ten  days  previous  to  the 
experiment  passed  an  average  of  724.5  cc.  of  urine,  the  specific 

*  See  article  by  Marcuse  on  Advantagers  of  Distilled  Water  as  a  Beverage 
in  Nephritis,  Berliner  Klinische  Wochenschrift,  xliv,  No.  14,  1907.  See  p. 
405;  Winckler,  Zeitschr.  f.  diet.  u.  physik.  Therap.,  Bd.  viii,  H.  10,  p.  567. 


DISTILLED   WATER  399 

gravity  varying  from  1.019  to  1.025;  the  albumin  ranging 
from  1.35  to  2.25  per  cent,  by  Esbach's  scale.  During  the  sub- 
sequent ten  days,  in  which  from  1  to  1|  liters  of  distilled  water 
were  given  daily,  the  average  amount  of  urine  was  1326  cc. — 
an  increase  of  83  per  cent.  The  specific  gravity  was  gradually 
lowered  to  1.007,  and  the  amount  of  albumin  excreted  remained 
about  the  same.  The  increased  diuresis  was  not  accompanied  by 
an  increase  in  the  amount  of  solid  constituents  in  the  urine,  but 
rather  the  reverse.  Under  the  use  of  Pyrmont  water,  however, 
during  the  next  twenty  days  the  total  amount  of  urine  slightly 
increased  to  1610  cc,  and  the  amount  of  albumin  passed  was 
slightly  greater.  Marcuse's  conclusions  are  that  distilled  water 
has  not  the  slightest  injurious  effect  on  the  organism.  This 
conclusion  was  borne  out  by  further  studies  by  Axel  Winckler, 
Marcuse,  and  others. 

The  purer  the  water  the  greater  is  the  capacity  for  the  solu- 
tion and  the  eUmination  of  the  unnecessary  salts  produced  in 
the  process  of  digestion  and  assimilation.  The  food  should 
provide  all  the  necessary  salts  in  abundance,  and  hence  distilled 
water,  or  the  chemically  indifferent  waters,  are  best  for  constant 
use.  The  author  does  not  wish  to  be  construed  as  depreciating 
the  value  of  the  more  highly  mineralized  waters.  They  are 
undoubtedly  valuable  for  purgative  and  other  purposes  and 
favor  elimination  through  the  bowels.  They  have  their  place 
for  occasional  use.  Other  individuals  seem  to  require  the 
constant  use  of  an  alkaline  water,  but  the  average  man  is  better 
off  on  the  purest  water  he  can  find. 

American  waters  containing  a  minimum  of  salts  are  the 
following:  Maine — Poland  Springs,  Highland  Springs,  Mount 
Hartford  Spring;  Vermont — Equinox  Spring;  Massachusetts — ■ 
Commonwealth  Mineral  Spring,  Massasoit  Spring,  Nobscot  Moun- 
tain Spring;  Connecticut — Stark  Mineral  Spring;  New  York — ■ 
Colonial  Springs,  L.  I.,  Great  Bear  Water,  Sun  Ray  Water, 
Ellen ville,  N.  Y.;  Pennsylvania — Glen  Summit  Water,  Ros- 
common Spring;   Maryland — Bentley  Spring. 


400  HYDROTHERAPY 

WATER  DRINKING   IN  DISEASE 

Obesity. — Authorities  differ  greatly  regarding  the  use  of 
water  in  this  condition.  Mr.  Banting,  who  reduced  himself 
in  a  year  from  202  to  156  pounds,  limited  the  total  daily  amount 
of  fluid  to  35  ounces.  Oertel  allows  8  to  16  ounces  of  water, 
12  ounces  of  wine,  and  2  cups  of  coffee,  tea,  or  milk  daily.  In 
hot  weather  the  amount  of  fluid  may  be  slightly  increased,  and 
should  be  taken  in  small  portions  through  the  day.  Schweninger 
suppresses  all  beverages  at  meals,  and  allows  no  fluid  until  two 
hours  have  elapsed  since  food.  Germain  See,  on  the  other  hand, 
allows  large  quantities  of  warm  aromatic  drinks.  No  doubt 
this  is  the  best  course  in  fat  and  gouty  people,  and  such  patients 
may  be  allowed  i  pint  of  water  after  each  meal  and  at  bed- 
time. Where  physical  exercise  is  required,  and  especially  when 
depleting  baths  are  used,  water  should  be  allowed.  Even  dur- 
ing meals  some  water  should  be  taken  to  aid  in  the  solution  and 
digestion  of  food,     (See  p.  197.) 

In  treating  poorly  nourished  persons,  water  may  be  added 
to  milk  in  the  proportion  of  2  tablespoonfuls  of  hot  water  to  a 
glass  of  milk,  to  which  is  added  5  gr.  each  of  common  salt  and 
sodium  bicarbonate.  In  this  way  the  digestibility  of  the  milk 
is  favored. 

Bronchitis. — In  all  cases  of  bronchitis  with-  hard  and  ineffect- 
ive cough,  water  generally  gives  relief.  Warm  drinks  before 
retiring  will  frequently  allay  cough,  and,  as  every  mother  knows, 
a  drink  of  water  will  often  stop  a  persistent  cough  in  children 
after  settling  for  the  night. 

Measles  and  Bronchopneumonia. — Cold  water  in  quantities 
from  4  to  6  ounces  should  be  given  to  children  with  measles  and 
bronchopneumonia,  and  repeated  every  two  or  three  hours. 

In  nephritis  it  is  generally  held  that  the  free  use  of  water 
internally  is  beneficial.  Certainly  a  glassful,  taken  night  and 
morning  on  an  empty  stomach,  will  act  as  an  eliminant.  It 
does  not  follow,  however,  that  where  much  is  good  more  is  better. 
It  is  quite  possible  to  flood  the  heart  and  arteries  with  water  and 


WATER    DRINKING    IN   DISEASE  401 

seriously  overtax  them.  Ascites  is  a  very  evident  counterin- 
dication.  The  underlying  motive  in  giving  water  and  milk  ex- 
tensively is  to  flush  the  kidneys  and  aid  the  elimination  of  toxins 
or  other  irritants. 

Prof,  von  Noorden,  however,  in  his  monograph  on  Nepliritis, 
takes  the  ground  that,  as  water  is  always  very  badly  excreted 
by  the  kidneys  when  they  are  acutely  diseased,  and  frequently 
also  in  subacute  and  subchronic  forms  of  nephritis,  the  extensive 
use  of  milk  and  water  is  not  logical:  "A  condition  of  hydremia 
must  be  regarded  as  a  constant  source  of  irritation  of  the  kidneys, 
and  the  problem  that  confronts  us  is  to  prevent  excessive  stimu- 
lation of  these  organs  as  much  as  possible."  ^ 

Concentration  of  Blood-serum  after  Talcing  Much  Water. — 
Engel  and  Scharl  were  unable  to  discover  that  the  blood-serum 
became  less  concentrated  after  ingestion  of  large  amounts  of 
water  followed  by  copious  voiding  of  urine.  No  hydremia  to 
speak  of  is  observed  under  such  conditions,  either  in  the  healthy 
or  in  those  with  kidney  affections.  On  the  contrary,  an  actual 
increase  in  the  concentration  of  the  blood-serum  may  be  noticed, 
sometimes  at  the  time  of  the  greatest  diuresis. 

It  has  been  frequently  noted  that  water  from  glacier  ice  has 
an  injurious  effect  on  the  gastric  mucous  membrane,  independent 
of  its  low  temperature. 

Some  difference  might  be  expected  according  to  whether 
hypoisotonic  water  or  hyperisotonic  water  were  used.  Grube 
used  the  former  and  found  a  very  slight  increase,  but  Grossmann,^ 
with  waters  of  both  these  classes,  found  no  essential  alteration 
in  his  own  person.  In  cases  of  disease,  however,  the  result  might 
be  different. 

Unless  the  heart  be  seriously  at  fault,  the  author  believes  in 
giving  water  moderately  in  nephritis,  especially  pure  or  the 
slightly  mineralized  waters,  skimmed  milk,  ginger  ale,  etc. 
People  vary,  but  water  drinking  is  certainly  in  most  cases  a 
piiysiologic,  hygienic,  and  remedial  measure  of  value. 

^  Berliner  Klinische  Wochenschrift,  xliv,  No.  14. 
2  Grossmann,  Deutsche  Med.  Woch.,  1903,  276. 
26 


402  HYDROTHERAPY 

A  draught  of  cold  water  may  reduce  the  frequency  of  the 
pulse  and  cause  a  slight  fall  in  the  body  temperature,  especially 
in  the  internal  temperature  as  measuretl  in  the  rectum  (Weber). 

In  typhoid  fever  cool  water  should  be  administered  in  small 
quantities  at  frecjuent  and  definite  intervals.  It  may  be  pos- 
sible in  tliis  way  to  give  as  much  as  2  or  3  quarts  in  twenty-four 
hours.  The  amount  of  urine  is  increased,  the  nervous  symptoms 
are  lessened,  and  the  patients  are  made  more  comfortable.  The 
internal  use  of  cold  water  is  a  good  adjuvant  to  the  cold  bath 
and  it  is  believed  to  lessen  the  mortality. 

The  method  adopted  by  E.  F.  Gushing  and  T.  W.  Clarke  in 
100  cases  treated  by  tliis  method  was  to  give  not  less  than  3  pints 
daily.  It  was  fountl  that  the  amount  of  water  that  patients 
would  take  could  be  greatly  increased.  The  quantity  often 
reached  1  or  IV  gallons.  This  was  accomplished  by  giving 
4  ounces  of  water  every  fifteen  minutes  during  the  waking 
hours.  In  addition,  the  patient  received  alternately,  6  ounces 
of  milk  and  6  ounces  of  albumen-water  every  two  hours  during 
the  day  and  once  or  twice  at  night,  representing  some  3  pints 
of  fluid.  Besides  all  tliis,  a  bowl  of  ice- water  was  kept  by  the 
bedside,  so  that  the  patient  could  help  himself.  An  occasional 
patient  rebelled  at  first,  but  the  majority  took  the  water  readily 
and  some  greedily.  The  natural  result  was  first  a  great  increase 
in  urine,  which  rose  as  high  as  8  to  12  pints,  and  was  maintained 
at  tliis  standard  during  the  febrile  part  of  the  disease.  Fewer 
baths  were  required  and  headaches  were  not  so  troublesome, 
the  mouth  w^as  noticeably  clean  and  moist,  and  the  nervous  and 
toxemic  symptoms  less.  There  were  few  complications,  and  the 
mortality  as  well  as  the  severity  of  typhoid  fever  seems  to  be 
lessened  by  this  free  use  of  water  internally.  We  have  not 
noted,  however,  any  great  tendency  to  adopt  these  suggestions. 
It  is  possible  that  the  method  is  open  to  objections. 

Heart  Disease. — In  general,  it  may  be  said  that  mineral 
waters  containing  lime  salts  should  be  avoided  by  patients  with 
heart  disease.  Lime  is  believed  to  raise  the  blood-pressure,  and 
an  excess  of  fluid  has  ob\ious  disadvantages.      Those  with  mitral 


ALKALINE   WATERS  403 

lesions  should  reduce  the  intake  of  fluid  to  about  2  pints  a 
day. 

In  valvular  heart  disease,  especially  in  imperfectly  com- 
pensated mitral  disease,  in  obese  people  with  weakly  acting 
hearts,  and  in  patients  suffering  from  atony  of  the  stomach  with 
dilatation,  water  should  be  restricted.  People  who  work  hard 
in  a  hot  atmosphere  are  liable  to  habitually  drink  a  large  quantity 
of  water  or  beer,  and  suffer  from  digestive  disturbances  due  to  a 
weakening  of  the  gastric  juice.  Bakers  and  men  in  breweries 
may  have  what  is  known  as  a  chronic  hydremic  plethora,  which 
favors  dropsy  and  degenerative  changes  in  the  heart  and  blood- 
vessels.^ 

SPECIFIC  VALUE  OF  MINERAL  WATER 

ALKALINE  WATERS 

These  are  sodic  or  sodic-magnesic  or  alkaline  chalybeate  or 
calcic.  The  best  waters  of  the  first  group  are  Saratoga  Vichy, 
Ukiah  Vichy,  Cal.;  St.  Louis  Spring,  Mich.;  Manitou,  Colo.; 
and  California  Seltzer.  They  are  rather  more  potent  than  the 
corresponding  foreign  waters. 

The  principal  European  waters  of  this  class  are  those  of  Vals, 
in  the  Ardeche,  France;  at  Karlsbad,  Austria;  Vichy,  in  France; 
in  the  Auvergne  Mountains,  Bi|in  and  Marienbad,  in  Bohemia; 
Fachingen,  Wildungen,  Ems,  and  Apollinaris  in  Germany. 
Apollinaris  is  found  the  world  over,  and  as  a  table  water  is  par 
excellence.  The  Vichy  Celestin,  or  Grand  Grille,  is  also  widely 
sold  in  America.  This  water  is  of  great  value  to  dyspeptics 
with  strongly  acid  urine,  to  gouty  and  rheumatic  subjects,  to 
patients  with  biliary  calculi,  and  to  patients  having  eczema 
or  psoriasis  associated  with  markedly  acid  tendencies.  A 
tumblerful  may  be  taken  two  or  three  times  a  day,  but  not  con- 
tinued, as  a  rule,  more  than  two  or  three  months  at  a  time. 

The  author  has  never  seen  any  bad  results  from  taking 

^  See  Climatotherapy  and  Balneotherapy,  by  Sir  Hermann  Weber  and 
F.  Parkes  Weber,  London,  1907,  p.  301. 


404  HYDROTHERAPY 

Cclcstin  Vichy  for  long  periods,  notwithstanding  very  extensive 
use  of  this  water.  He  is  personally  acquainted  with  a  gentle- 
man who  has  had  attacks  of  gall-stones,  and  has  used  the  water 
almost  daily  with  benefit  during  a  period  of  over  two  years. 

Waters  of  the  Carlsbad  type,  hot  sodic-magnesic  alkaline 
waters,  are  especially  valuable  in  hyperchlorhydria  and  ulcer 
of  the  stomach.  Exceptional  cases  arise,  but  in  general  it  may 
be  said  that  Carlsbad  is  especially  useful  in  completing  the  cure 
of  gastric  ulcer.  Chronic  catarrhal  conditions  of  the  gastro- 
intestinal tract  do  best  at  Carlsbad.  Patients  with  constipation 
and  hemorrhoids  are  more  successfully  treated  with  the  colder 
waters  of  Kissingen. 

Fachingen  water  has  a  great  reputation  in  Germany,  owing 
partly  to  the  fact  that  the  emperor  is  reported  to  take  it  daily. 
It  has  been  subjected  to  elaborate  tests  by  Klemperer,^  who 
demonstrated  that  the  weak  alkaline  urine  produced  by  Fach- 
ingen water  can  actually  dissolve  concretions  of  uric  acid;  100 
cc.  of  a  twenty-four-hour  specimen  of  a  patient's  urine  were 
taken  in  three  days,  and  a  uric-acid  stone  was  immersed  for 
twenty-four  hours  in  each  specimen.  In  the  faintly  alkaline 
urine  there  was  a  slight  loss;  in  acid  urine,  on  the  other  hand, 
there  was  an  infinitesimal  gain.  By  drinking  a  bottle  of  Fach- 
ingen water  daily  the  free  uric  aid  fell  practically  to  nil  (von 
Noorden). 

Observations  such  as  those  on  calculi  already  excreted  are 
no  doubt  encouraging,  but  the  important  matter  to  determine  is 
the  value  of  these  alkaline  waters  in  controlling  the  excretion 
of  uric  acid  in  true  uric-acid  gout.  There  is  a  great  deal  of 
misconception  as  to  the  value  of  mineral  waters  in  this  respect. 
Patients  are  invariably  disappointed  if  larger  quantities  of  uric 
acid  are  excreted  after  the  ingestion  of  such  waters;  and  how- 
ever encouraging  to  the  physician  such  a  temporary  circumstance 
may  be,  the  patient  always  wants  to  know  that  the  output  is 
reduced. 

In  gout,  according  to  von  Noorden,  w^th  or  without  uratic 

1  Behandlung  der  Neirensteinkrankheit,  Therapie  der  Gegenwart,  1904, 337. 


ALKALINE-CALCAREOUS   OR   EARTHY  MINERAL  WATERS      405 

deposits,  the  normal  average  excretion  of  uric  acid  and  purin 
bases  is,  as  a  rule,  not  quite  attained,  and,  in  spite  of  our  ignor- 
ance of  the  pathology  of  gout,  increased  uric-acid  excretion 
must  be  regarded  as  a  good  sign,  provided  it  be  not  due  to 
increased  uric-acid  formation.  This  latter  process  may  be  set 
up  by  an  increased  intake  of  purin  bodies,  perhaps  by  alcohol  or 
even  certain  drugs;  but  inorganic  substances,  as  far  as  ascer- 
tained, produce  no  such  result.^ 

THE  ALKALINE-CALCAREOUS  OR  EARTHY  MINERAL  WATERS 

These  waters  contain  calcium  carbonate  or  sulphate  and  are 
valuable  for  their  antacid  and  diuretic  properties.  As  a  rule, 
they  are  well  borne  by  the  stomach,  counteracting  hyperacidity 
of  the  stomach  and  urinary  tract.  For  this  reason  they  are 
largely  used  for  the  treatment  of  gout  and  rheumatism,  but 
too  large  a  quantity  of  calcium  sulphate  is  a  disadvantage  to 
the  stomach,  and  renders  the  water  somewhat  difficult '  of 
digestion. 

It  is  noteworthy  that  even  after  the  drinking  of  large  quanti- 
ties of  mineral  water  containing  calcium  carbonate  or  sulphate 
only  traces  of  calcium  are  found  in  the  urine.  Most  of  this  is  un- 
absorbed  or  is  excreted  by  the  large  intestine,  von  Noorden 
shows  that  an  important  and  beneficial  reaction  follows;  that 
calcium  in  the  intestinal  canal  before  its  absorption,  and  perhaps 
also  during  its  re-excretion  into  the  bowel,  combines  with  phos- 
phoric acid,  and  so  prevents  the  latter's  transference  to  the 
kidneys  and  urine.  Thus  the  total  amount  of  phosphates  in  the 
urine  is  diminished,  and,  as  the  reaction  of  the  urine  approaches 
alkalinity,  the  proportion  of  disodium  to  monosodium  phosphates 
is  modified  in  favor  of  the  former. 

Most  of  these  waters  in  the  natural  state  contain  considerable 
quantities  of  carbonic  acid  gas,  and,  therefore,  are  best  used 
at  their  source.  Calcium  salts  are  eagerly  sought  by  the  acids 
of  imperfect  digestion.     The  latter  readily  combine  with  the 

^  See  Von  Noorden,  Metabolism  and  Practical  Medicine,  vol.  iii,  p.  949, 
English  edition. 


406  HYDROTHERAPY 

bases  thus  furnished,  and  probably  in  this  manner  obviate  union 
with  similar  bases  found  in  bone,  cartilage  of  joints,  and  in  other 
natural  tissues  of  the  body.  A  proper  selection  of  food,  such  as 
vegetables  rich  in  salts,  accomplishes  a  similar  purpose,  and 
this  diet  goes  hand  in  hand  with  the  use  of  mineral  waters  in 
the  treatment  of  these  affections. 

Calcareous  mineral  waters  favorably  influence  rheumatism 
of  a  subacute  or  chronic  type,  gout,  gravel,  pyelitis  from  kidney 
connection,  chronic  gonorrhea,  broncliial  catarrh  ^ith  profuse 
secretion,  and  allied  affections.  They  are  credited  with  favor- 
able results  in  scrofulosis,  rachitis,  and  osteomalacia. 

The  cold  calcareous  waters  most  used  in  the  United  States 
are  those  of  the  Healing  Springs,  Virginia  (25  gr.  per  gallon); 
Bedford  Springs,  Pennsylvania  (107  gr.  CaSO^  per  gallon); 
Greenbrier  White  Sulphur  Spring,  W.  Va.  (78  gr.  CaS04  per 
gallon) ;  CUfton  and  Richfield  Springs,  New  York  (69  gr.  CaSO^ 
and  112  gr.  CaSO^  per  gallon);  Napa.  Soda  Spring,  California 
(10  gr.  CaCO,),  and  Manitou  Springs,  Colorado  (65  gr.  CaCOj 
per  gallon). 

The  most  extensively  used  thermal  calcareous  waters  are  at 
Hot  Springs,  Arkansas  (7  gr.  CaCO.,).  Equally  efficacious  springs 
of  this  class  are  found  in  the  Virginias,  Kentucky,  Michigan, 
New  York,  and  Pennsylvania,  some  of  them  having  rather  more 
than  local  reputation. 

In  Europe  cold  earthy  waters  of  wide  reputation  and  popu- 
larity are  found  at  Marienbad  in  Bohemia,  Contrexe\ille  in 
France,  Wildungcn  in  Germany,  Leukerbad  in  Switzerland,  and 
Bath  in  England.  Of  this  class  the  waters  of  Contrexe\'ille  are 
best  known  and  most  used  in  the  United  States.  The  waters  of 
Kreuznach,  Germany,  are  of  this  class,  containing  chlorin,  iodin, 
and  bromin  in  combination  with  the  earthy  bases.  They  are 
used  internally  for  tertiary  syphilides  and  strumous  diseases. 

SALINE  WATERS;  MURIATED  SALINE  WATERS 
Springs  of  salt  water  have  been  used  for  ages  in  Europe,  the 
most  famous  being  those  of  Homburg,  Kissingen  (Rakocsy), 


SALINE  waters;  muriated  saline  waters  407 

Karlsbad  (Sprudel),  Soden,  Friedrichshall,  Nauheim  in  Germany; 
Hall  and  Salzburg  in  Austria;  Cheltenham  and  Leamington  in 
England. 

In  the  United  States  the  best  springs  of  this  class  are  those 
of  Saratoga,  Ballston  Spa,  Syracuse,  and  Glen  Springs,  New 
York;  Mount  Clemens,  Michigan;  Upper  Blue  Lick,  Kentucky; 
Eureka  Springs,  California;  and  Waukesha,  Wisconsin.  There 
are  numerous  salt  wells  in  Texas  and  Kansas.  In  Canada, 
Caledonia  Springs,  Sandwich  Springs,  and  St.  Catherine's  Well, 
all  in  Ontario,  have  rather  more  than  local  reputation.  They 
are  purgative,  and  exert  secondarily  a  good  effect  on  the  liver 
and  gastro-intestinal  functions.  Their  reputation  having  rested 
for  years  on  a  purely  empiric  foundation,  it  is  highly  gratifying 
to  note  the  recent  attempts  to  determine  the  true  physiologic 
action  of  these  waters. 

Effects  on  Metabolism. — We  are  indebted  to  von  Noorden, 
of  Frankfort,  and  Carl  Dapper,  of  Kissingen,  for  the  best  exposi- 
tion of  the  effects  of  saline  waters  on  metabolism.^  Their 
observations  were  made  on  persons  undergoing  a  drinking 
cure  for  various  affections,  comprising  anacidity,  subacidity, 
and  hyperacidity  of  the  gastric  juice,  chronic  intestinal  catarrh, 
gastric  ulcer,  obesity,  diabetes  mellitus,  and  the  effects  of  alcohol. 
One  observation  made,  and  a  curious  one,  was  that  in  numerous 
cases  of  gastric  disorder,  particularly  in  gastric  catarrh,  the  use 
of  saline  mineral  waters  leads  to  an  active  and  permanent  in- 
crease in  the  production  of  hydrochloric  acid.  On  the  other 
hand,  in  cases  accompanied  by  hyperacidity,  particularly  in 
nervous  dyspepsia,  the  moderate  use  of  saline  mineral  waters 
leads  to  a  decrease  of  the  hydrochloric  acid  production  and  a 
decrease  of  the  subjective  symptoms.  That  a  given  remedy 
should  work  a  cure  in  cases  of  a  diametrically  opposite  nature 
is  one  of  the  paradoxes  of  medicine.  But  the  high  standing 
of  these  clinicians,  and  the  great  care  shown  in  minute  exam- 
inations made  of  the  gastric  secretion  while  the  patients  were 

^  Diseases  of  Metabolism  and  Nutrition,  Part  V,  by  Carl  von  Noorden 
and  Carl  Dapper;   American  edition  by  Boardman  Reed,  1904. 


408  HYDROTHERAPY 

undcr  observation,  IcAvc  no  doubt  that  the  conclusions  are 
correct. 

In  so  refractory  a  condition  as  hyperacidity  no  one  mineral 
water  has  been  found  a  panacea.' 

Another  important  point,  brouglit  out  by  the  observations 
referred  to  above,  is  that  the  administration  of  saline  mineral 
waters  docs  not  call  for  any  particular  diet.  Arbiti'ary  and 
routine  dietetic  regulations  are  in  vogue  at  many  health  resorts. 
There  is  a  popular  prejudice  among  many  physicians,  and  it 
is  shared  by  the  general  public,  that  each  particular  saline 
water  calls  for  the  exclusion  of  certain  definite  atricles  of  food 
from  the  diet  regardless  of  the  disease.  In  other  words,  that 
each  water  calls  for  a  definite  dietary.  The  governing  principle 
should  be  that  the  diet  should  be  adapted  to  the  particular  needs 
of  the  patient,  and  not  be  given  in  a  routine  way,  according 
to  the  water  prescribed.  Although  this  antiquated  method  is 
not  confined  to  European  resorts,  it  is  probably  more  commonly 
employed  in  Europe  than  in  America. 

That  the  use  of  fats  should  be  forbidden  while  taking  saline 
waters  is  one  of  the  fallacies  that  the  authors  quoted  above 
have  pointed  out.  They  make  the  valuable  practical  point  that 
many  patients  need  the  fats  of  a  normal  diet  to  maintain  their 
nutrition  and  strength.  Undoubtedly,  there  are  patients  with 
gastric  and  intestinal  trouble,  with  diabetes  or  gout,  many 
neurasthenics  and  convalescents  from  various  diseases  who  need 
fats,  and  who  are  perfectly  able  to  digest  and  assimilate  them. 
That  they  are  assimilated  the  records  plainly  show. 

The  use  of  saline  waters  does  not  affect  the  proteid  metab- 
olism, and  hence  they  are  suitable  in  cases  of  overfatness  in 
which  it  is  never  desirable  to  diminish  the  proteid  contents  of 
the  body.  Several  investigators  have  published  the  results 
of  experiments  on  animals  and  in  healthy  persons,  showing  a 

^  "To  argue,  as  is  done,  that  because  simple  saline  waters  are  beneficial 
in  subacidity,  therefore  they  are  contraindicated  in  hj'peracidity,  is  a  form 
of  cleverness  which  rejects  facts  and  opposes  the  free  growth  of  knowledge." — 
von  Noorden. 


SALINE  waters;  muriated  saline  waters  409 

slight  increase  in  the  excretion  of  urea  after  the  ingestion  of 
sodium  chlorid,  but  von  Noorden's  conclusion  that  proteid 
metabolism  is  not  appreciably  affected  is  generally  believed  to 
be  correct.  In  adopting  a  milk  diet  the  small  quantity  of  salt 
present  is  not  usually  considered  a  disadvantage;-  water  in  this 
case  is  eliminated  freely. 

Saline  waters  should  never  be  administered  to  patients  with 
nephritis^  especially  when  edema  is  present.  This  is  now  con- 
sidered bad  practice,  and  much  light  has  been  thrown  on  the 
danger  of  chlorid  retention  by  the  works  of  Widal  and  others. 
A  salt-free  dietary  is  enjoined,  and  hence  chalybeate  waters,  cal- 
careous waters,  and  other  waters  devoid  of  salt  are  to  be  chosen. 
An  edema  which  has  disappeared  in  the  course  of  nephritis,  may 
be  caused  to  reappear  when  salt  is  ingested.  It  is  best  to  avoid 
salt  in  any  case  of  albuminuria.  We  believe  its  use  is  positively  • 
counterindicated . 

As  a  laxative  and  cathartic  good  saline  waters  like  Congress 
and  Hathorn  have  for  years  had  a  great  reputation  in  the  United 
States.  All  the  Saratoga  waters  and  those  of  Mt.  Clemens  have 
a  large  saline  content. 

It  is  impossible  and,  perhaps,  unnecessary  in  this  work  to 
discuss  fully  the  large  question  of  the  role  of  chlorid  retention  in 
nephritis.  An  excellent  presentation  of  this  subject  was  made 
to  the  American  Medical  Association  in  June,  1909,  by  Drs. 
Victor  C.  Vaughan,  John  H.  Musser,  Henry  A.  Christian,  Edward 
F.  Wells,  D.  L.  Edsall,  Rochester,  Tyson,  and  others.^ 

Widal  and  Javal's  discovery  has  evidently  influenced  medical 

practice  throughout  the  world.     It  is  pretty  well  agi^eed  that  a 

reduction  in  the  amount  of  sodium  chlorid  ingested,  aside  from 

any  influence  on  edema,  helps  largely  to  reduce  the  work  that  the 

kidneys  do;  that  an  amount  of  sodium  chlorid  no  more  than 

that  equal  to  what  is  taken  in  an  ordinary  daily  diet  may  cause 

^  See  full  report  in  Jour.  Amer.  Med.  Assoc,  November  27,  1909.  See  also 
La  Cure  de  Dechloruration  dans  le  Mai  de  Bright  et  daus  quelques  Maladies 
Hydropigenes;  Par  le  Dr.  Fernand  Widal  et  le  Dr.  Adolphe  Javal,  Paris,  Bal- 
liere,  1906;  ibid.,  Bull,  et  Mem.  de  la  Soc.  Med.  des  Hop.  de  Paris,  1903, 
p.  733;  Delearde,  L'Echo  Med.  du  Nord,  January  20,  1907. 


410  HYDROTHERAPY 

decided  failure  of  function  on  the  part  of  the  kidney,  even  in 
cases  in  which  the  kidney  appears  to  be  tloing  fairly  good  work 
(Edsall).  We,  therefore,  shoukl  be  on  our  guard  not  to  allow 
patients  with  scarlet  fever  or  in  any  stage  of  nephritis  to  di'ink 
waters  containing  sodium  chlorid  in  any  appreciable  quantity.' 

Regarding  the  excretion  of  the  uric  acid  the  conclusion  is 
that  in  cases  of  gout  the  use  of  saline  waters  (e.  g.,  Kissingen, 
Rakocsy)  causes  an  increase,  amounting  occasionally  to  as  nmch 
as  .2  grams  a  tlay,  although  in  exceptional  cases  no  change  can 
be  noted.  In  another  case  of  gout,  recently  examined  in  von 
Noorden's  laboratory,  it  was  found  that  the  use  of  saline  and 
sulphate  waters  did  not  produce  any  increase  of  the  fecal  purins. 

As  an  example  of  what  may  be  expected,  the  following  case 
of  Dr.  F.  K.  may  be  quoted:  Age  fifty-five;  frequent  attacks 
of  gout  for  fifteen  years.  Chronic  gouty  changes  in  the  joints 
with  tophi  in  the  ears  and  hands.  There  has  been  \rdm  and 
swelling.  The  subject  was  obese,  and  showed  great  muscular 
weakness.  He  had  a  diet  of  meat,  mashed  potato,  salad  at 
dinner  and  supper,  bread  and  butter,  two  oranges,  a  bottle 
of  mild  Bordeaux  wine,  and  a  bottle  of  Apollinaris  water.  For 
four  days  his  average  excretion  of  uric  acid  was  .566  grams. 
For  the  next  five  days  he  was  given  800  cc.  Homburg  Elizabeth 
water  (686  gr.  salt  per  gallon)  in  place  of  an  equal  amount  of 
Apollinaris  water.  The  average  excretion  of  uric  acid  was  then 
.765  grams.  In  the  after-period,  in  which  he  returned  to  the 
original  solid  and  Uquid  diet,  the  excretion  was  .695  grams. 
This  shows  that  saline  waters  have  a  useful  place  in  the  treat- 
ment of  gout.     Similar  cases  arc  cited  by  von  Noorden.- 

There  need  be  no  interdiction  of  raw  fruit  while  using  saline 
mineral  waters,  unless  the  individual  case  demand  it.  The 
drinking  of  saline  waters,  or  of  any  other  water  per  se,  does  not 
call  for  the  restriction  of  any  particular  article  of  food. 

1  The  Hindu,  Charaka,  advised  a  salt-free  diet  in  Ascites,  1000  b.  c. 

•  Dr.  Leonard  Williams,  of  London,  takes  strong  ground  against  the  use 
of  sodium  chlorid  waters  in  the  treatment  of  gout.  Jour,  of  Balneology  and 
Climatology,  Jan.,  1907.     The  author  heartily  endorses  this  position. 


SEA  WATER  411 

SEA  WATER 

In  a  recent  number  of  the  Repertoire  de  Pharmacie  M.  P. 
Carles  gives  an  interesting  account  of  the  use  of  sea  water  in 
medicine.  In  addition  to  common  salt,  sea  water  contains  many- 
important  mineral  substances,  the  total  solid  matter  amounting 
to  3.2  to  3.8  per  cent.  Some  of  these  substances  are  present  only 
to  an  infinitesimal  extent,  but  in  biology  the  value  of  a  substance 
is  not  necessarily  dependent  upon  its  actual  size  or  quantity. 
It  has  been  shown  that  various  marine  plants  have  the  power 
of  extracting  from  sea  water  minute  quantities  of  compounds 
of  iodin,  bromin,  arsenic,  boron,  manganese,  lithium,  fiuorin, 
rubidium,  cesium,  and  other  elements.  Hence  it  is  not  unreason- 
able to  suppose  that  the  higher  animals  might  derive  benefit  from 
the  assimilation  of  even  minute  traces  of  these  physiologically 
active  substances.  The  employment  of  sea  water  as  a  remedial 
agent  dates  back  to  the  time  of  Hippocrates,  and  modern  physio- 
logic investigations  have  led  to  its  reintroduction  into  medicine. 
Thus  it  has  been  shown  that  if  a  portion  of  the  blood-serum 
of  a  dog  be  replaced  by  an  artificial  serum,  the  most  suitable 
serum  for  the  purpose  is  sea  water,  isotonic  with  the  natural 
serum.  Sea  water  has  been  given  by  the  mouth  and  by  injec- 
tion with  good  results  in  cases  of  dyspepsia,  loss  of  appetite,  and 
tuberculosis.  In  general,  the  appetite  was  improved  and  strength 
was  rapidly  regained. 

In  order  to  obtain  the  best  and  most  immediate  results  it  is 
necessary  to  observe  certain  precautions.  The  sea  water  must 
be  natural,  as  it  is  impossible  to  imitate  so  complex  a  liquid. 
Indeed,  it  has  been  proved  that  sea  salt,  when  redissolved  in 
distilled  water,  lacks  some  of  the  properties  of  natural  sea  water, 
exerting  a  toxic  action  upon  a  dog  when  injected  subcutaneously. 
It  must  be  freshly  collected,  as  it  loses  carbon  dioxid  on  standing, 
with  precipitation  of  some  of  its  salts.  It  should  be  taken, 
from  the  open  sea,  remote  from  rivers  and  other  sources  of  pol- 
lution. It  should  be  sterilized  by  filtration,  as  heat  dissociates 
the  bicarbonates  and  destroys  the  natural  equilibrium  of  the 
liquid. 


412  HYDROTHERAPY 

When  required  for  subcutaneous  injection  sea  water  should 
be  tUluted  with  water  to  the  same  concentration  as  normal 
blood-serum.  Distilled  water  is  not  suitable  as  a  diluent,  as 
it  sometimes  causes  pain.  It  is  better  to  dilute  the  sea  water 
with  natural  potable  water  in  the  proportion  of  2  parts  to  5. 
In  conclusion,  M.  Carles  points  out  that  this  method  of  treatment 
is  not  invariably  suitable,  and  that  it  rests  with  clinical  experi- 
ence to  indicate  the  cases  in  which  it  may  advantageously  be 
employed.* 

USE  OF  RADIO-ACTIVE  WATERS  INTERNALLY 

Little  is  known  of  this  use  of  mineral  waters.  They  have 
been  studied  by  Bickcll  and  Bergell  -  in  their  laboratory,  and  a 
definite  biologic  action  in  relation  to  digestion  is  claimed,  but 
we  are  far  from  any  exact  or  satisfactory  knowledge  of  the 
subject.  It  has  been  shown  by  M.  Curie  that  any  radio-activity 
present  in  mineral  waters  is  dissipated  shortly  after  bottling, 
the  radio-active  gas  and  water  losing  about  50  per  cent,  of  its 
activity  in  four  days.  Consequently,  efforts  to  bottle  waters 
charged  with  radium  gas  will  prove  useless  regarding  their  radio- 
active properties.  Taken  at  their  source  they  may,  however,  be 
valuable. 

Bergell  and  Bickell  say  that  the  retarding  effect  of  the 
peptonizing  process  which  certain  saUne  waters  exert  is  found 
only  when  the  water  has  lost  its  radio-activity.  The  presence 
of  radium  emanation,  although  by  itself  inactive  as  regards 
the  process  of  secretion,  either  abolishes  the  retarding  power 
of  saline  water  or  overcompensates  it.  Incomplete  as  these 
researches  are,  a  good  deal  of  truth  lies  in  the  statement  that 
there  is  a  real  difference  between  the  physiologic  workings  of 
a  water,  taken  fresh  from  the  spring  at  its  maximum  of  radio- 

*  Lancet,  January  4,  1908.  See  also  R.  Simon  and  R.  Quinton,  Soci^te 
de  Th^rapeutique,  Paris,  January  24,  1906;  also  Quinton's  L'Eau  de  Mer, 
Milieu  Organique,  Masson  and  Cie,  Paris. 

2  Bickell  and  Bergell,  Physiol.  Bedent.  der  Radioaktivitat  der  Mineral- 
wasser,  xxii,  Kongress  f.  innere  Med.,  1905,  p.  157. 


SULPHUR   WATERS  413 

activity,  and  those  of  the  same  water  altered  by  transportation 
and  storage.^ 

BITTER  OR  PURGATIVE  "WATERS 

These  belong  to  the  class  of  sodic-potassic-magnesic  sulphated 
muriated  saline  waters.  The  best  examples  are  those  of  Puellna, 
Hunjadi,  Apenta,  Franz  Josef,  Victoria  of  Austria;  Seidlitz, 
Bohemia;  Carabana  and  Riibinat,  Spain.  The  waters  of  Crab 
Orchard  and  Harrodsburg,  Kentucky;  Abilena  Spring,  Kansas; 
Castalia  Springs,  California;  and  Clark's  Riverside  Spring, 
Michigan,  are  examples  of  the  same  class.  They  are  purgative 
by  stimulating  intestinal  peristalsis,  stimulant  to  the  stomach 
and  to  the  flow  of  bile.  The  foreign  waters  of  this  class  are  used 
to  an  enormous  extent  in  America  for  the  relief  of  constipation, 
especially  by  plethoric  persons. 

The  advantage  of  the  Hunjadi  waters  is  that  the  sulphates 
of  magnesium  and  sodium  are  in  nearly  equal  proportions,  and 
the  taste  is  not  so  objectionable  as  when  one  or  the  other  pre- 
ponderates. The  strongest  purgative  water  known  is  the  Vic- 
toria Ofener.  It  contains  a  large  proportion  of  magnesium 
sulphate  and  is  a  particularly  disagreeable  water.  The  Franz 
Josef  Spring  is  a  strong  aperient,  containing  nearly  equal  parts 
of  the  sulphates  of  sodium  and  magnesium.  The  dose  of  these 
waters  is  a  small  wineglassful  diluted  with  warm  water;  they 
should  be  taken  in  the  morning  on  rising.  Free  purgation  is 
obviously  a  great  help  in  promoting  a  proper  function  of  the 
stomach  and  the  skin,  and  aids  the  action  of  drugs. 

SULPHUR  WATERS 

These  waters  are  characterized  by  the  presence  of  hydrogen 
sulphid  or  the  sulphids  of  sodium,  potassium,  calcium,  or  mag- 
nesium in  connection  with  other  salts,  such  as  the  -chlorids  of 
sodium  and  potassium  and  the  earthy  salts.  Unless  they  con- 
tain at  least  5  cubic  inches  of  hydrogen  sulphid  per  gallon  or 

1  Confer  von  Noorden,  Metabolism  and  Practical  Medicine,  vol.  iii,  p.  910, 
London,  1907. 


414  HYDROTHERAPY 

5  gr.  of  sulpliids,  much  stress  cannot  be  laid  on  the  sulphur 
as  a  potent  factor.  Waters  of  weaker  composition  are  very 
numerous,  and,  though  bearing  the  title  of  sulphur  springs,  are 
useful  rather  by  reason  of  their  thermal  qualities  or  through  other 
constituents,  usually  alkaline — saline.  The  advantages  of  these 
salts  have  been  discussed.     (See  p.  403  et  seq.) 

When  well  charged  with  sulphur,  these  waters  are  useful  in 
diseases  of  the  liver  and  spleen,  and  probably  also  in  gout, 
rheumatism,  and  such  skin  diseases  as  acne  and  scrofulous 
eruption.  The  list  of  sulphur  waters  is  very  long;  they  abound 
in  New  York,  Virginia,  West  Virginia,  Alabama,  Michigan,  Cali- 
fornia, and  Ontario,  Canada.  In  England  the  Harrogate  waters 
have  marked  sulphurous  properties;  so  also  those  of  Strath- 
pefTer,  in  Scotland,  Aachen,  or  Aix-la-Chapelle  of  Rhenish 
Prussia,  Baden  and  Nenndorf  in  Prussia;  Luchon,  Bareges, 
and  Cautorets,  in  France;  Baden  near  Vienna,  and  many 
others. 

The  opinion  has  been  expressed  that  sulphurcted  hydrogen 
has  been  greatly  overrated  as  a  therapeutic  agent  in  mineral 
waters,  notwithstanding  the  general  opinion  of  its  virtues.  Its 
value  must  be  taken  in  connection  with  the  mineral  salts  with 
which  it  is  associated.  In  a  case  of  nervous  hyperacidity  von 
Noorden  has  made  some  tests  with  the  water  of  the  Weilbach 
sulphur  spring  (5.2  cc.  HjS  per  liter) ;  400  cc.  of  this  water  were 
taken  half  an  hour  before  the  test-breakfast,  and  the  stomach 
contents  were  removed  by  siphonage  forty  minutes  after  the 
meal.  Four  consecutive  washings  gave  a  total  acidity  of  91 
(decinormal  soda  solution  per  100  cc.  of  gastric  juice)  and  an 
average  for  HCl  of  62;  after  four  washings  the  total  acidity  was 
reduced  to  42.  The  general  conclusion  is  that  the  water  im- 
proves the  appetite  and  stimulates  the  gastric  functions.  Where 
there  is  a  moderate  content  of  sodium  chlorid  this  no  doubt  is 
the  case;  but  where  calcium  sulphate  is  present  in  large  quanti- 
ties symptoms  of  indigestion  are  liable  to  occur. 


CHALYBEATE   WATERS;   "  STEEL   WATERS"    OF   EUROPE      415 

CHALYBEATE  WATERS;    "STEEL  WATERS"  OF  EUROPE 

These  waters  contain  from  1  to  150  gr.  of  ferrous  sulphate  or 
carbonate  per  gallon,  and  are  usually  combined  with  other 
more  active  ingredients.  They  are  usually  carbonated,  and  are 
agreeable  to  the  stomach  unless  associated  with  much  alum, 
when  their  astringent  properties  predominate.  They  are  useful 
in  the  anemias  and  in  general  debility;  when  astringent,  they 
are  valuable  in  chronic  diarrhea,  ulcer  of  the  stomach,  malarial 
cachexia,  gout,  rheumatism,  eczema,  and  psoriasis;  when  as- 
sociated with  arsenic,  they  are  useful  in  chlorosis,  scrofula,  and 
other  lymphatic  diseases. 

The  principal  simple  iron  waters  in  the  United  States  are 
those  of  Iron  Ute  Springs,  Manitou,  Colorado;  Rock  Enon 
Springs,  Va.;  Napa  Soda  Springs  and  Pacific  Congress  Springs, 
California.  In  Europe  the  principal  chalybeate  springs  are 
those  of  Bocklet,  Franzensbad,  Marienbad,  Pyrmont,  and  Schwal- 
bach,  Germany;  Tunbridge  Wells,  Flitwick,  containing  170  gr. 
of  persulphate  of  iron  per  gallon,  Cheltenham,  and  Brighton, 
England;   Spa,  Belgium;   and  St.  Moritz,  Switzerland. 

Among  the  astringent  iron  waters  (FeSOJ  may  be  mentioned 
Church  Hill  Alum  Spring,  Rockbridge  Alum,  and  Bedford  Alum 
Springs,  Virginia;  Oak  Orchard  Spring,  Genesee  County,  New 
York;  St.  Anne's  Well  at  Brighton,  England,  belongs  to  this 
class. 

Weak  arsenic  iron  waters  are  found  at  Crockett  Arsenic  Li- 
thia  Spring,  Virginia;  at  Ashley's  Bromin  and  Arsenic  Spring 
and  Thompson's  Bromin- Arsenic  Spring  in  North  Carolina.  The 
best  and  strongest  waters  of  this  class  are  in  Europe.  Those 
most  used  are  from  Roncegno  and  Levico,  in  the  Austrian 
Tyrol;  Lansigk,  in  Saxony;  and  Royat,  in  the  Puy  de-Dome, 
France. 

These  waters  are  administered  in  doses  of  one  or  two  table- 
spoonfuls  daily  and  the  dose  is  gradually  increased.  The 
Roncegno  water  contains  .1  gram  of  arsenic  per  liter  and  the 
other   waters  from  4  to  9  milligrams.     They  should   be   well 


410  HYDROTHERAPY 

diluted,  and  taken  about  half  an  hour  att(>r  meals.  The  ferrous 
sulphate  is  present  in  quantities  varying  from  2.56  to  4.18  grams 
per  liter  (179  to  292  gr.  per  gallon).  The  Saint  Victor  Spring 
at  Ro3'at  is  used  particularly  for  psoriasis. 

Chalybeate  waters  always  give  the  best  results  when  taken 
directly  from  the  spring,  because,  if  much  lime  be  present,  as  is 
frequently  the  case,  the  iron  precipitates  after  bottling,  and 
hence  they  do  not  bear  transportation  well.  The  waters  of 
Schwalbach,  on  that  account,  keep  better  than  those  of  Pyrmont, 
which  contain  lime  in  abundance.  Those  from  the  Prince  de 
Conde  Spa  keep  best  of  all,  and  may  be  given  in  quantities  of 
from  1  to  4  or  5  tumblerfuls  a  day.  They  aid  digestion  and 
improve  the  blood. 

Experience  seems  to  show  that  the  natural  iron  waters  are 
more  beneficial  in  chlorosis  and  anemia  than  the  various  pharma- 
ceutic preparations  of  iron.  This  is  probably  due  to  its  better 
solution.  They  are  counterindicated  when  fever  is  present,  in 
severe  disturbances  of  the  digestive  organs,  and  in  pulmonary 
tuberculosis  with  hemoptysis. 

SODIC-BROMO-IODIN  WATERS 

Sodium  bromid  and  iodid  arc  found  associated  with  sodium 
chlorid,  and  are  quite  subordinate  to  the  excess  of  the  latter  salt. 
The  chief  European  waters  of  this  class  are  those  of  Kreuznach, 
Purton  Spa,  and  Woodhall.  The  last  is  the  strongest  known, 
containing  nearly  5  gr.  of  bromin  and  |  gr.  of  iodin  to  the  gal- 
lon. The  Saratoga  Springs,  such  as  Congress  and  Hat  horn. 
Eureka,  Excelsior,  Champion,  and  Geyser,  belong  to  this  class, 
the  Ypsilanti  Mineral  Well,  the  Port  Huron  Mineral  Bath  of 
Michigan,  and  about  sixty  others  in  the  United  States. 

The  bromo-iodin  waters  are  of  value  in  the  treatment  of 
scrofula,  syphilis,  goiter,  and  diseases  of  the  skin,  but  are  counter- 
indicated  in  chronic  inflammatory  states  of  the  digestive  organs, 
unless  the  sodium  iodid  and  bromid  be  insignificant  in  com- 
parison with  other  valuable  constituents. 


LITHIA   WATERS  417 

LITHIA  WATERS 

These  have  a  great  vogue  in  the  United  States,  and  are 
widely  advertised  as  such,  whether  they  contain  j-^^q-q  gr.  per 
gallon  or  upward.  All  the  Saratoga  Springs  are,  comparatively 
sp'eaking,  rich  in  lithia.  The  Londonderry  and  Buffalo  lithia 
waters  are  widely  used.  The  White  Rock  Lithia,  a  water  from 
Waukesha,  Wisconsin,  is  an  artificial  Hthia  water,  to  which  20 
gr.  of  lithium  carbonate  was  formerly  added  before  bottling.  It 
is  no  doubt  fully  as  efficacious  even  now  as  any  of  the  strictly 
natural  lithia  waters,  and  is  very  widely  used  as  a  table  water. 
It  is  generally  suppUecl  carbonated. 

"Buffalo  Lithia  is  a  water  coming  from  an  American  spring 
or  springs,  advertised  as  containing  a  definite  C|uantity  of  lithia, 
namely,  2.25  gT.  per  U.  S.  gallon,  while  the  government  analyses 
find  much  smaller  amounts;  and,  according  to  the  analysis  made 
by  Prof.  F.  Waller,  the  water  contains  but  0.018  gr.  of  lithium 
bicarbonate  per  gallon. 

"Rhens  water,  the  product  of  a  German  spring,  is  freed  of 
its  iron,  recarbonated,  and  then  bottled. 

''Londonderry  Lithia,  an  American  water,  advertised  to  con- 
tain 7.29  gi'.  per  gallon,  contains  but  a  spectroscopic  trace  of  lithia, 
an  amount  too  small  to  be  expressed  in  weight. 

"Geneva  Lithia  Water,  again  an  American  product,  said  to 
contain  23.8  parts  per  million  of  lithia,  is  found  to  contain  but 
0.1  part;  in  other  words,  one  would  have  to  consume  something 
like  80  gallons  to  get  a  single  medicinal  dose  of  the  advertised 
drug. 

"Bear  Lithia,  an  American  product,  contains  only  a  trace  of 
lithia."  1 

The  late  Dr.  James  K.  Crook,  who  spent  years  in  the  study 
and  classification  of  the  American  mineral  waters,  recognized 
that  the  medical  profession  are  in  a  state  of  inexcusable  ignorance 
regarding  the  chemic  constitutents  of  many  of  our  mineral  waters 
and  the  worthlessness  of  many  advertised  analyses. 

"  The  fact  must  not  be  overlooked  that  the  government  anal- 

^  See  article  by  Julius  Greyer,  Jour.  Amer.  Med.  Assoc,  Aug.  3,  1907. 
27 


418  HYDROTHERAPY 

yses  were  made  in  each  case  from  samples  purchased  in  the  open 
market.  It  is,  therefore,  possible  that  some  of  the  waters  ex- 
amined by  the  bureau  chemists  were  spurious  or  adulterated. 

"The  chemic  ingredients  set  forth  in  the  table  of  contents 
of  mineral  springs  represent  hypothetic  combinations  only.  No 
chemist  maintains  that  the  salts  he  sets  down  in  his  analysis 
exist  in  exactly  that  form  in  the  water.  He  ascertains  by  his 
tests  the  various  acid  and  basic  ions  existing  in  the  water,  and, 
as  nearly  as  possible,  in  what  amounts.  He  then  reasons  that 
they  unite  to  form  the  salts  which  go  to  make  up  his  hypothetic 
table  of  contents,  which  is  ppesented  as  the  analysis.  It  is  hardly 
conceivable  that  any  two  chemists  separately  examining  a  speci- 
men of  spring  water  taken  from  its  source,  even  at  the  same 
moment,  would  reach  exactly  the  same  result  in  stating  the 
theoretic  combination.  How  much  greater  discrepancy  might 
reasonably  be  expected  in  the  case  of  analyses  separated  by 
periods  of  thirty  or  forty  years. 

All  of  our  medicinal  springs  should  be  submitted  to  analysis 
at  least  once  in  ten  years,  until  we  are  able  to  arrive  at  a  correct 
estimate  of  their  potency,  and  whether  they  are  gaining  or  losing 
in  strength.  No  enterprising  mineral  spring  proprietor,  ani- 
mated by  a  desire  to  put  forth  a  reliable  product,  can  object  to 
the  expense,  repeated  at  intervals  so  widely  separated.  The 
decennial  revisions  of  our  works  on  materia  medica  and  phar- 
macy should  present  a  brief  account  of  the  mineral  waters  con- 
forming to  ethical  rules,  so  that  the  medical  practitioner  may  be 
in  possession  of  as  authentic  and  authoritative  a  source  of  in- 
formation regarding  these  as  he  has  in  case  of  other  therapeutic 
agents."  ' 

Among  European  waters  containing  lithia  are  those  of  BiUn, 
in  Bohemia;  Elizabeth-brunnen,  at  Homburg;  Konigsquelle, 
at  Elster  in  Saxony;  Rakocsy  Spring,  at  Kissingen  in  Bavaria, 
and  Wilhemsquelle,  at  Ems,  in  Prussia. 

Value  of  Lithia  Waters. — These  waters  are  credited  with  a 
solvent  action  on  the  uric  acid,  and  hence  they  appeal  strongly 

1  Therapeutic  Gazette,  May,  1908. 


WATER  AS   AN   EMETIC  419 

to  those  who  believe  that  an  excess  of  uric  acid  is  the  fundamental 
cause  of  rheumatism,  gout,  arthritis,  and  other  allied  conditions. 
This  doctrine  is  usually  given  a  prominent  place  in  circulars  re- 
garding mineral  springs,  and  is  impressed  on  patients  at  various 
water-cure  resorts  so  generally  that  it  is  a  part  of  the  confession 
of  faith  at  most  health  resorts  supplied  with  lithia  waters.  There 
should  be  a  revision  of  the  accepted  teaching  on  this  point :  it  is 
necessary  to  distinguish  between  the  truth  and  poetry  of  uric  acid. 

The  trend  of  all  recent  investigations  leads  to  the  conclusion 
that  uric  acid  is  only'  one  of  the  numerous  excrementitious 
products  in  the  diseases  in  which  it  has  been  accorded  such  a 
prominent  role.  Nevertheless,  its  importance  for  trade  purposes 
is  such  that  no  very  radical  change  can  be  expected  in  this  time- 
honored  terminology. 

Undoubtedly,  lithia  waters  do  good.  If  free  from  common 
salt  and  used  with  judgment  and  in  moderation  they  are  applic- 
able in  cases  of  nephritis  of  all  grades,  rheumatism,  gout,  espe- 
cially of  the  chronic  forms,  and  are  unquestionably  better  than 
the  glass  of  water  in  which  the  5-gr.  effervescent  tablet  has  been 
dissolved.  When  lithia  is  given  in  the  latter  form  it  is  too 
strong  for  prolonged  use  and  is  liable  to  derange  the  stomach. 
The  natural  waters,  or  those  to  which  a  quantity  (not  over  20 
gr.  per  gallon)  has  been  added,  are  free  from  these  objections. 

Under  the  provisions  of  the  "pure  food  law"  the  United 
States  Government  has  taken  steps  to  insure  proper  labels  on 
mineral  waters,  so  that  the  public  may  not  be  misled.  On  May 
3,  1910,  in  the  United  States  Court  at  Harrisburg,  Pennsylva- 
nia, a  mineral  spring  water  companj^  was  fined  $25  and  costs 
for  advertising  its  water  to  contain  lithia  in  quantity  to  make 
it  of  medicinal  value  when  analysis  showed  barely  a  trace. 

WATER  AS  AN  EMETIC 

Finally,  water  may  be  used  as  an  emetic.     The  time-honored 
use  of  lukewarm  water,  or  slightly  saline  warm  water,  needs  little 
comment.     In  cases  of  poisoning,  especially  in  ptomain-poison- 
.  ing,  this  simple  remedy  should  be  instantly  applied. 


420 


HYDROTHERAPY 


COMPARISON  OF  THERMOMETERS 


Fahr. 

Cent. 

Fahr. 

Cent. 

Fahr. 

Cent. 

212 

100 

150 

65.6 

90 

32.2 

210 

98.9 

148 

64.4 

88 

31.1 

208 

97.8 

146 

63.3 

86 

30 

206 

96.7 

144 

62.2 

84 

28.9 

204 

95.6 

142 

61.1 

82 

27.8 

202 

94.4 

140 

60 

1    80 

26.7 

200 

93.3 

138 

58.9 

1    78 

25.6 

198 

92.2 

136 

57.8 

76 

24.4 

196 

91.1 

134 

56.7 

1    74 

23.3 

194 

90 

132 

OO.O 

72 

22.2 

192 

88.9 

130 

54.4 

i    70 

21.1 

190 

87.8 

128 

53.3 

68 

20 

188 

86.7 

126 

52.2 

66 

18.9 

186 

85.6 

124 

51.1 

1    64 

17.8 

184 

84.4 

122 

50 

i    62 

16.7 

182 

83.3 

120 

48.9 

1    60 

15.6 

180 

82.2 

118 

47.8 

58 

14.4 

178 

81.1 

116 

46.7 

56 

13.3 

176 

80 

114 

45.6 

54 

12.2 

174 

78.9 

112 

44.4 

52 

11.1 

172 

77.8 

110 

43.3 

50 

10 

170 

76.7 

108 

42.2 

,    48 

8.9 

168 

75.6 

106 

41.1 

!    46 

7.8 

166 

74.4 

104 

40 

44 

6.7 

164 

73.3 

102 

38.9 

42 

5.6 

162 

72.2 

1    100 

37.8 

40 

4.4 

160 

71.1 

98 

36.7 

38 

3.3 

158 

70 

96 

35.6 

36 

2.2 

156 

68.9 

94 

34.4 

34 

1.1 

154 

67.8 

92 

33.3 

32 

0. 

152 

66.7 

PRESCRIPTIONS   FOR   HYDROTHERAPY 

It  is  necessary  to  specify  the  temperatures  of  the  water  to 
be  used,  the  duration  of  each  feature  of  the  treatment,  and,  if 
douches  are  called  for,  the  pressure  required.  These  ought  to 
be  intelligently  and  concisely  stated  by  the  physician,  as  in  a 
prescription  for  any  other  remedy.  Abbreviations  are  naturally 
used  and  are  understood  by  bathing  attendants.  In  institutions 
where  large  numbers  are  bathing  these  prescriptions  are  kept  in 
a  convenient  place,  well  lighted,  for  frequent  reference  during 
the  progress  of  the  bath. 


PEESCEIPTIONS  421 

The  abbreviations  most  frequently  used  are  as  follows : 

L.  B.,  Electric-light  baths. 

Pn.,  Perspiration. 

H.  A.  B.,  Hot-air  bath  or  electric-light  bath.     Either  may  be  used. 

C.  D.,  Circular  or  needle  douche. 

R.  D.,  Rain  douche  or  descending  douche. 

S.  D.,  Scotch  douche  or  alternate  jet  douche. 

F.  D.,  Fan  douche  or  spray  douche. 

J.  D.,  Jet  douche. 

<^,  Increasing  temperature  to. 

>,  Decreasing  temperature  to. 

Comp.,  Compress. 

Fo.,  Fomentation. 

Rev.  Comp.,  Revulsive  compress. 

H.  and  C.  Sp.,  Alternate  hot  and  cold  to  the  spine. 

H.  and  C.  Hd.,  Alternate  hot  and  cold  to  the  head. 

Simul.  H.  and  C.  Hd.,  Simultaneous  hot  and  cold  to  the  head. 

C.  Comp.,  Cold  compresses. 

Pk.,  Pack. 

Ch.  Pk.,  Chest  pack. 

Dry  Ch.  Pk.,  Dry  chest  pack. 

C.  M.  F.,  Cold  mitten  friction. 

W.  H.  R.,  Wet  hand  rub. 

C.  T.  R.,  Cold  towel  rub. 

W.  Sh.  R.,  AVet  sheet  rub. 

Dr.  Sh.  R.,  Drip  sheet  rub. 

S.  GL,  Salt  glow. 

Spg.,  sponge. 

Ale.  R.,  Alcohol  rub. 

O.  R.,  Oil  rub.  ^ 

H.  Ft.  B.,  Hot  foot-bath. 

C.  Ft.  B.,  Cold  foot-bath. 

H.  and  C.  Ft.  B.,  Hot  and  cold  foot-bath. 

Lg.  B.,  Leg  bath. 

H.  i  B.,  Hot  half-bath. 

C.  S.  B.,  Cold  shaUow  bath. 
Alk.  B.,  Alkaline  bath. 

E.  L.  B.,  Electric-light  bath. 
H.  B.  Pk.,  Hot  blanket  pack. 

D.  B.  Pk.,  Dry  blanket  pack. 
Elect.  Pk.,  Electrothermal  pack. 

PRESCRIPTIONS 

In  the  Medical  Baths  of  Boston,  which  have  been  estab- 
lished under  the   guidance  of   Dr.  J.  H.  Pratt,  Dr.  J.  J.  Put- 


422  HYDROTHERAPY 

nam,  and  others,  there  is  an  excellent  system  of  prescriptions 
and  medical  observation  and  reports.  See  Hydrotherapeutic 
Prescriptions,  by  Joseph  H.  Pratt,  Boston  Med.  and  Surg. 
Journal,  March  17,  1904;  also,  An  Introduction  to  the  Use 
of  Hydrotherapy  in  Chronic  Diseases,  by  J.  H.  Pratt.  Among 
the  prescriptions  used  by  Dr.  Pratt,  Dr.  Baruch,  and  the  author 
are  the  following : 

(1)  Hot  pack  until  skin  is  warm  and  cutaneous  vessels 
dilated.  Wet-mit  friction  with  water  at  60°  F.  (15.6°  C). 
Repeat  daily,  reducing  water  temperature  2  degrees  daily  until 
50°  F.  (10°  C.)  is  reached. 

(2)  Electric-light  bath  imtil  skin  is  moist,  or  for  five  or  ten 
minutes,  followed  by  wet-mit  friction,  using  cold  water  at  50° 
or  60°  F.  (10°  or  15.6°  C). 

(3)  Hot-air  cabinet  bath  until  the  skin  is  warm.  Wet-mit 
friction  with  water  at  60°  F.  (15.6°  C),  reducing  the  tempera- 
ture of  water  daily  until  water  at  50°  F.  (10°  C.)  is  used. 

Nos.  1  to  3  are  useful  in  anemia,  neurasthenia,  nervous 
dyspepsia,  debility,  malnutrition,  etc, 

(4)  Hot-air  bath  or  electric-light  bath  to  perspiration.  C.  D., 
105°  >  80°  F.  (40.6°  >  26.7°  C),  two  minutes;  20  pouhds. 
F.  D.,  75°  F.  (23.9°  C),  fifteen  seconds.    Alcohol  rub. 

(5)  H.  A.  B.  to  Pn.  (temperature  160°  to  170°  F.— 71.1°- 
76.7°  C).  C.  D.,105°>90°F.  (40.6°  >  32.2°  C),  two  minutes; 
20  pounds.  J.  D.,  90°  >  80°  F.  (32.2°  >  26.7°  C),  one  minute; 
15  pounds.  F.  D.,  80°  F.  (32.2°  C),  ten  seconds;  15  pounds. 
Lower  minimum  temperature  2  degrees  and  increase  pres- 
sure 2  pounds  each  treatment,  until  a  temperature  of  60°  F. 
(15.6°  C.)  and  a  pressure  of  30  pounds  are  used.  General 
tonic. 

(6)  H.  A.  B.  to  Pn.,  temperature  160°  to  170°  F.  (71.1°- 
76.7°  C).  C.  D.,  95°  >  80°  (35°  >  26.7°  C),  thirty  seconds. 
F.  D.,  70°  F.  (21.1°  C),  five  seconds:  30  pounds.  General 
massage,  ten  minutes.  Reduce  temperature  of  F.  D.  1  degree 
daily. 

(7)  H.  A.  B.  or  electric-light   bath,  fifteen  to  twenty-five 


PEESCRIPTIONS  423 

minutes.  Dry  pack,  thirty  minutes.  Rest  in  bed,  one  hour. 
This  is  useful  in  chronic  parenchymatous  nephritis  and  in 
anemia. 

(8)  H.  A.  B.  or  electric-light  bath  to  Pn.  C.  D.,  105°  > 
90°  F.  (40.6°  >  32.2°  C),  two  minutes:  20  pounds.  Scotch 
douche  (S.  D.)  to  affected  part  or  painful  areas,  thirty  seconds. 
Repeat  daily.  Pressure  to  be  regulated  from  10  to  20  pounds, 
according  to  sensibility  and  general  resistance.  Useful  in  cases 
of  arthritis. 

(9)  Vapor  bath,  120°  F.  (48.9°  C),  ten  minutes.  S.  D.  to 
painful  parts,  twenty  to  thirty  seconds.  Hot  dry  pack,  thirty 
minutes.  Rest  in  bed,  one  hour.  Repeat  on  alternate  days. 
Useful  in  neuralgia  and  in  muscular  and  articular  rheumatism. 

(10)  H.  A.  B.  almost  to  Pn.  C.  D.,  105°  >  95°  F.  (40.6° 
>  35°  C),  one  minute.  S.  D.,  small  caliber,  to  course  of  colon, 
115°  and  60°  F.  (46.1°  and  15.6°  C),  fifteen  seconds  for  each 
temperature;  15  pounds,  one  to  two  minutes.  F.  D.  to  chest 
and  back,  75°  F.  (23.9°  C),  ten  seconds.  Repeat  daily,  increasing 
pressure  2  pounds  daily  until  30  pounds  are  used.  Useful  in 
constipation. 

(11)  Hot-air  bath  until  cutaneous  vessels  are  dilated.  Wet 
sheet  rub.  Sitz-bath,  temperature  70°  F.  (21.1  °  C.) ,  ten  minutes. 
Simultaneous  hot  foot-bath,  temperature  110°  F.  (43.3°  C). 
Repeat  daily,  increasing  duration  gradually  to  twenty  minutes 
and  lowering  temperature  to  50°  F.  (10°  C).     Diarrhea. 

(12)  Hot-air  bath  to  perspiration.  Circular  douche,  105°  to 
95°  F.  (40.6°-35°  C),  one  minute.  Ascending  douche,  60°  to 
70°  F.  (15.5°-21.1°  C),  two  to  three  minutes,  5  to  10  pounds' 
pressure.  Rain  douche,  105°  F.  (40.6°  C),  thirty  seconds.  Fan 
douche  to  entire  body,  ten  seconds,  15  pounds,  70°  F.  (21.1°  C). 
Hemorrhoids;  hypertrophy  of  the  prostate. 

(13)  Hot-air  bath  to  point  of  perspiration.  Circular  douche, 
105°  to  90°  F.  (40.6°-32.2°  C),  two  minutes.  Jet  and  fan 
douche,  90°  to  80°  F.  (32.2°-26.7°  C),  15  pounds,  one  minute. 
Jet  douche  to  spine,  75°  F.  (23.9°  C),  fifteen  seconds.  Lower 
minimum  temperature  2  degrees  and  increase  pressure  1  pound 


424  HYDROTHERAPY 

each  application  until  pressure  of  35  pounds  and  temperature 
of  50°  F.  (10°  C.)  are  reached.    General  tonic. 

(14)  Hot-air  bath  until  cutaneous  vessels  arc  dilated.  Re- 
move before  perspiration  begins.  Circular  douche,  95°  to  85°  F. 
(35°-29.4°  C),  one-half  to  one  minute.  General  fan  douche, 
80°  F.  (26.6°  C),  20  pounds,  t(Mi  to  twenty  seconds.  Dry  rapidly. 
AValk  in  open  air  until  somewhat  fatigued.  Repeat  daily, 
reducing  minimum  temperature  1  tlegree  each  treatment.  Once 
during  week  allow  patient  to  perspire  five  minutes  in  cabinet. — 
Baruch.     General  tonic. 

(15)  Hot-air  bath  almost  to  point  of  perspiration.  Circular 
douche,  95°  to  85°  F.  (35°-29.4°  C),  one-half  to  one  minute. 
Fan  douche  to  back,  75°  F.  (23.9°  C),  20  pounds,  five  seconds. 
General  fan  douche,  78°  F.  (25.6°  C.\  30  pounds,  fifteen  seconds. 
After  several  days  substitute  jet  douche  for  fan  douche  to  back, 
lower  temperature  of  general  fan  douche  1  degree  daily. — Baruch. 
For  neurasthenia. 

(16)  Hot-air  bath  to  beginning  perspiration.  Circular  douche, 
25  pounds,  95°  to  80°  F.  (35°-26.7 °  C),  one  minute.  Jet  douche 
to  back,  30  pounds,  75°  F.  (23.9°  C),  five  seconds,  daily  reduced 
1  degree.  Friction.  Walk  in  open  air. — Baruch.  For  neuras- 
thenia of  moderate  grade. 

(17)  Hot-air  bath  to  beginning  perspiration.  Circular  douche, 
10  pounds,  105°  to  92°  F.  (40.6°-33.3°  C),  three  minutes. 
General  fan  douche,  10  pounds,  85°  F.  (29.4°  C),  fifteen  seconds. 
Walk  slowly  in  the  open  air.  Repeat  daily,  increasing  pressure 
and  lowering  temperature  until  15  pounds  and  80°  F.  (26.7°  C.) 
are  reached. 

(18)  Hot-air  bath  to  point  of  perspiration.  Change  cold 
compresses  to  head  frequently.  Circular  douche,  100°  to  90°  F. 
(37.8°-32.2°  C),  two  minutes.  Scotch  or  alternate  jet  douche 
to  legs  and  feet,  15  pounds.  Repeat  daily,  increasing  pressure  1 
pound  each  application  until  30  pounds  are  borne.  Arthritis  of 
the  feet. 

(19)  Wet  pack;  temperature  of  water  60°  to  70°  F.  (15.6°- 
21.1°  C),  one  hour.     Circular  douche,  85°  F.   (29.4°  C),  20 


PRESCRIPTIONS  425 

pounds'  pressure,  fifteen  seconds.  Repeat  daily;  once  or  twice 
weekly  initial  temperature  of  circular  douche,  90°  F.  (32.2°  C), 
reduce  quickly  to  75°  F.  (23.9°  C),  followed  by  fan  douche, 
85°  to  65°  F.  (29.4°-18.3°  C),  20  pounds'  pressure,  five  seconds. 
— M.  F.  Jacohi  and  Baruch. 

(20)  Hot-air  bath  to  perspiration.  Circular  douche  bath,  25 
pounds' pressure  at  80°  F.  (29.4°  C),  thirty  seconds.  Spray 
douche,  65°  F.  (18.3°  C),  five  seconds.  After  a  few  applications, 
use  jet  douche  to  spine  at  end  of  treatment  for  thre'e  seconds, 
temperature  65°  F.  (18.3°  C).  Lower  temperature  of  jet  2  de- 
grees daily  until  50°  F.  (10°  C.)  is  reached.  If  this  is  well 
borne,  pressure  may  be  increased  2  pounds  daily  until  30  pounds 
are  reached. — Baruch. 

(21)  Vapor  bath,  120°  F.  (48.9°  C),  15  minutes.  Ice-bag  to 
precordia.  Salt  glow.  Jet  douche  to  entire  body,  10  pounds, 
110°  F.  (43.3°  C),  thirty  seconds.  Rub  dry.  Rest  in  bed  one 
to  two  hours.  Repeat  two  to  four  times  weekly,  increasing 
pressure  until  30  pounds  are  employed,  and  gradually  increasing 
length  of  vapor  bath  to  thirty  minutes.  For  chronic  paren- 
chymatous nephritis. 

(22)  Hot  full  bath,  100°  F.  (37.8°  C),  raised  to  106°  F.  (41.1° 
C),  five  to  ten  minutes.  Salt  glow.  Fan  or  jet  douche  to  entire 
body,  110°  F.  (43.3°  C),  thirty  seconds.  Massage  to  edema- 
tous portions.  Rest  one  to  two  hours  before  dressing.  Repeat 
two  to  four  times  weekly,  increasing  pressure  until  30  pounds 
are  used.     For  chronic  parenchymatous  nephritis. 

(23)  Hot-air  bath,  forty  to  sixty  minutes.  Soap  shampoo. 
Half-bath,  temperature  70°  F.  (21.1°  C),  three  to  five  minutes. 
General  jet  douche,  pressure  25  pounds,  temperature  70°  F. 
(2L1°  C),  twenty  seconds.  Dress  quickly  and  walk  until 
fatigued.  Repeat  daily,  increasing  duration  of  hot-air  bath 
and  lowering  temperature  of  douche  as  condition  of  patient 
indicates. 


426  HYDROTHERAPY 

Prescriptions  in  use  at  the  Medical  Baths,  Boston: 

Prescriplion  A. — Light  cabinet,  five  to  seven  minutes 
Cold  wet  mit  friction  to  entire  body. 
Temperature  of  water,  70°  F.  (21.1°  C). 

Repeat  daily,  gradually  reducing  temperature  of  water  to  60°  F.  (15.5°  C.) 
or  lower. 

Prescription  B. — Light  bath,  five  to  ten  minutes. 

Circular  douche,  105°  F.  (40.5°  C.),  thirty  seconds. 

Circular  douche,  90°  F.  (32.2°  ('.),  thirty  seconds. 

Jet  and'fan  douche  to  entire  body  at  70°  F.  (21.1°  C.),  twenty  seconds, 
pressure,  10  pounds. 

Repeat  daily,  gradually  increasing  pressure  of  j(>t  douche  and  lowering 
terminal  temperature  until  pressure  of  20  pounds  and  temperature  of  60°  F. 
(15.5°  C.)  are  used. 

It  is  written  in  an  abbreviated  form  as  follows : 

L.  B.,  five  to  ten  riiinutes. 

C.  D.,  105°  F.  (40.5°  C),  tlurty  seconds. 

C.  D.,  90°  F.  (32.2°  C),  thirty  seconds. 

J.  and  F.  D.,  70°  F.  (21.1°  C),  twenty  seconds. 

P.,  10  lb. 

Repeat  daily,  increasing  P.  to  20  lb.  and  reducing  T.  to  60°  F.  (15.5°  C). 

Prescription  C^Light  bath,  fifteen  to  twenty  minutes. 
Fan  douche,  105°  F.  (40.5°  C),  thirty  seconds. 
Fan  douche,  70°  F.  (21.1°  C.),  fifteen  seconds. 
Dry  rub. 
Rest  one  hour. 
Repeat  every  other  day. 

If  the  individual  is  weak,  a  milder  procedure  should  be  used 
(Prescription  A). 

Prescription  D. — Light  bath,  seven  to  twelve  minutes. 
Salt  rub. 

Circular  douche,  105°  F.  (40.5°  C),  thirty  seconds. 

Jet  and  fan  douche,  105°  F.  (40.5°  C),  thirty  seconds,  pressure,  15  pounds. 
Dry  rub. 

Rest  thirty  minutes. 
Repeat  three  times  weekly. 
Useful  in  chronic  interstitial  nephritis. 

In  cases  of  chronic  uremia,  headache,  loss  of  appetite,  and 
vomiting  it  is  well  to  use  a  wet  pack  (one  hour  or  longer)  pre- 
ceded by  a  light  bath  of  three  to  five  minutes'  duration. 


PRESCRIPTIONS  427 

Prescription  E. — Local  hot-air  or  electric-light  bath  to  affected  joint,  thirty 

minutes  to  one  hour. 
Electric-light  bath,  general,  three  to  five  minutes. 
Jet  douche  to  affected  joint,  105°  F.  (40.5°  C),  twenty  seconds. 
Jet  douche  to  affected  joint,  105°  F.  (40.5°  C),  twenty  seconds;  70°  F. 

(21.1°  C),  five  seconds. 
Repeat  four  times. 

Circular  douche  to  entire  body,  105°  F.  (40.5°  C),  thirty  seconds. 
Jet  and  fan  douche  to  entire  body,  70°  F.  (21.1°  C),  ten  seconds. 
All  douches  at  from  10  to  20  pounds'  pressure. 
Repeat  three  to  six  times  weekly,  increasing  pressure  gradually. 

Prescription  F. — Arc  light,  seven  to  ten  minutes. 
Light  bath,  five  to  ten  minutes. 
Alternate  douche  to  affected  part. 
Circular  douche,  105°  F.  (40.5°  C),  tliirty  seconds. 
Jet  and  fan  douche,  70°  F.  (21.1°  C),  ten  seconds,  pressure,  10  pounds. 
Repeat  daily,  increasing  pressure  gradually. 

Used  in  lumbago  and  sciatica. 

Prescription  G. — Hot-air  douche  to  painful  area,  fifteen  to  twenty  minutes. 

Light  bath,  five  to  ten  minutes. 

Circular  douche,  105°  F.  (40.5°  C),  thirty  seconds,  pressure,  10  pounds. 

Jet  and  fan  douche  to  entire  body,  70°  F.  (21.1°  C),  twenty  seconds,  pres- 
sure, 10  pounds. 

Repeat  daily.  Increase  pressure  of  jet  and  fan  douche  and  lower  terminal 
temperature  until  pressure  of  25  pounds  and  60°  F.  (15.5°  C.)  are  reached. 

Nauheim  Baths. — At  the  beginning  of  treatments  the  fol- 
lowing general  prescription  may  be  given : 

Prescription  H. — Carbon  dioxid  bath,  -j%  strength. 

Temperature,  93°  F.  (33.8°  C). 

Duration,  seven  minutes. 

Increase  strength  one-tenth  each  treatment,  lower  temperature  1  degree, 
and  increase  duration  one  minute. 

Prescription  I. — Carbon  dioxid  bath,  -^-^  strength. 

Temperature,  93°  F.  (33.8°  C). 

Duration,  ten  minutes. 

Increase  strength  of  bath  gradually,  lower  temperature  and  increase  dura- 
tion until  a  bath  of  eight-tenths  full  strength  87°  F.  (30.5°  C.)  and  twenty 
nainutes  is  given. 

Dr.  Pratt  finds  that  a  powerful  arc  light  is  of  service  in  the 
treatment  of  neuritis,  myalgia,  "rheumatic"  joints,  and  neural- 


428  HYDROTHERAPY 

gia,  paiiicularly  sciatica.  The  arc  light  in  use  at  the  Medical 
Baths  in  Boston  has  a  concave  parabolic  mirror,  so  that  the  rays 
of  light  can  be  focused  on  a  small  area  of  the  skin. 

In  obesity,  Dr.  Pratt  usually  uses  light  baths  followed  by 
cold  douches  (Prescription  D).  Later  in  the  treatment  dry 
blanket  packs  or  hot  full  baths  (105°  F.— 40.5°  C.  for  ten  or 
fifteen  minutes)  are  used  after  the  light  bath  if  prolonged  sweat- 
ing is  desired.  Hydrotherapy  without  careful  attention  to  diet 
and  exercise  is  valueless  in  the  treatment  of  obesity. 

In  chronic  irderstitial  nephritis,  short  stimulating  douch 
treatments  (Prescription  D)  and  carbon  dioxid  baths  hold  the 
first  place. 

In  diabetes,  Naunyn  and  von  Noorden  recognize  the  impo"rt- 
ance  of  hydrothcrapeutic  aids  to  the  dietetic  treatment.  Tonic 
measures  increase  metabolism,  invigorate  the  patient,  and  im- 
prove the  condition  of  the  skin  (Prescriptions  A  and  B). 

Local  Hot-air  and  Light  Baths. — In  chronic  arthritis  of  all 
forms  we  chiefly  use  local  light  and  hot-air  baths  followed  by  a 
cabinet  bath  of  short  duration,  and  then  give  an  alternating 
(Scotch)  douche  to  the  affected  or  painful  areas.  (See  Pre- 
scription E.) 

Nauheim  Baths. — Dr.  Pratt  informs  the  author  that  he 
usually  begins  a  course  of  treatments  with  baths  two-tenths  or 
i/hree-tenths  full  strength.  The  duration  of  the  first  bath  is 
seven  minutes  and  the  temperature  of  the  water  93°  F.  (33.8° 
C).  Gradually  the  strength  of  the  bath  is  increased,  the  tem- 
perature lowered,  and  the  duration  extended  to  fifteen  or  even 
twenty  minutes.  He  rarely  gives  a  bath  at  a  lower  temperature 
than  86°  F.  (30°  C). 

A  full  strength  bath  is  only  used  if  the  heart  has  considerable 
reserve  power,  and  then  only  toward  the  end  of  treatment. 

Use  in  Heart  Disease. — The  carbon  dioxid  baths  are  indicated 
in  the  milder  degrees  of  circulatory  disturbance,  when  there  is 
sUght  dyspnea  on  exertion  or  moderate  edema.  They  may  also 
be  of  value  in  cardiac  asthma  (paroxj'smal  dyspnea,  usually 
nocturnal)  and  in  milder  forms  of  angina  'pectoris.  They  are  of 
equal  service  in  the  cardiac  weakness  of  valvular  disease  and  in 


PRESCRIPTIONS  429 

that  due  to  myocardial  degeneration  alone.  They  are  contra- 
indicated  when  there  is  oppressed  breathing  with  the  patient  at 
rest  or  when  edema  is  marked. 

The  circulatory  organs  can  be  acted  on  reflexly  by  stimulating 
the  sensory  nerves  of  the  skin,  and  the  most  powerful  stimulus 
of  the  cutaneous  sensory  nerves  is  the  carbon  dioxid  bath.  The 
peripheral  vessels  are  narrowed,  but  as  there  is  an  increased 
flow  of  blood  through  them,  the  skin  becomes  reddened  and  there 
is  a  pleasant  sensation  of  warmth  produced.  The  blood-pressure 
is  elevated.  The  altered  distribution  of  the  blood  in  the  body 
is  an  aid  to  the  proper  functioning  of  the  heart.  The  breathing 
becomes  deeper  and  this  also  accelerates  the  flow  of  blood. 

If  the  bath  is  not  too  strong,  it  produces  a  slight  rise  in 
blood-pressure  when  given  at  a  temperature  between  85°  F. 
(29.4°  C.)  and  92°  F.  (33.3°  C).  In  treating  heart  cases  the 
physician  should  carefully  note  the  immediate  effect  of  the 
treatments.  He  should  be  present  occasionally  when  the 
strength  of  the  bath  is  increased.  It  is  important  to  percuss 
out  the  cardiac  outline  before  and  after  the  bath. 

Dr.  Pratt  is  a  firm  believer  in  the  superiority  of  the  local 
incandescent  light  baths  over  local  hot-air  baths.  The  radiant 
heat  of  the  light  bath  penetrates  the  tissues  to  a  greater  depth 
than  the  conducted  heat  of  the  hot-air  bath. 

The  following  is  a  list  of  general  stimulating  treatments  most 
commonly  used  at  the  Medical  Baths  in  Boston: 

(1)  The  ablution  (wet-mit  friction,  German  "Teilwaschung," 
see  p.  246).    A  mild  general  treatment. 

(2)  The  wet  sheet  pack  and  rub  (see  p.  237). 

(3)  The  half-bath.  Temperature  70°  to  85°  F.  (21.1°-29.4° 
C).     Duration  one  to  five  minutes  (see  p.  243). 

(4)  The  douches : 

(a)  Circular  douche,  60°  to  70°  F.  (15.5°-21.1°  C). 

.Pressure,  8  to  15  pounds;  duration,  fifty  to  sixty 

minutes. 
(6)  Jet  and  fan  douche,  60°  to  75°  F.  (15.5°-23.9°  C). 

Pressure,  10  to  25  pounds. 


430  HYDROTHERAPY 

(5)  The  faradic  electric  baths.  Temperature,  90°  to  93°  F. 
(32.2°-33.8°  C). 

(6)  The  carbon-dioxid  baths.  Various  strengths;  tempera- 
ture, 85°  to  92°  F.  (29.4°-33.3°  C).  Duration,  seven  to  fifteen 
minutes. 

The  chief  sedative  treatments  are  as  follows: 

(1)  The  wet  pack  (see  p.  340). 

(2)  The  dry  blanket  pack  (see  p.  345). 

(3)  The  hot-air  bath.  Temperature,  115°  to  140°  F.  (46.1- 
60°  C);  duration,  fifteen  to  twenty-five  minutes. 

(4)  The  electric-light  bath.  Temperature,  110°  to  140°  F. 
(43.3°-60°  C);  duration,  fifteen  to  thirty  minutes. 

(5)  The  neutral  full  bath.  Temperature  90°  to  93°  F.  (32.2°- 
33.8°  C);  duration,  ten  to  forty-five  minutes. 

(6)  The  hot  full  bath.  Temperature,  104°  to  108°  F.  (40°- 
42.2°  C);  duration,  five  to  ten  minutes. 

(7)  The  galvanic  bath.  Temperature,  90°  to  93°  F.  (32.2°- 
33.8°  C);  duration,  five  to  fifteen  minutes. 

(8)  The  sinusoidal  bath.  Temperature,  90°  to  93°  F.  (32.2°- 
33.8°  C);  duration,  five  to  fifteen  minutes. 

(9)  Electric-light  bath,  five  to  ten  minutes. 
Circular  douche  at  105°  F.  (40.5°  C),  thirty  seconds. 
Circular  douche  at  90°  F.  (32.2°  C),  thirty  seconds. 

Jet  and  fan  douche  to  entire  body  at  70  °  F.  (21.1°  C),  twenty 
seconds;  pressure  10  pounds. 

Repeat  daily,  gradually  increasing  pressure  of  jet  douche  and 
lowering  terminal  temperature  until  pressure  of  20  pounds  and 
temperature  of  60°  F.  (15.5°  C.)  are  used. 

Local  treatments  with  heat  produce  hyperemia  and  are 
used  chiefly  to  relieve  pain,  to  lessen  inflammation,  and  to 
improve  the  nutrition  of  the  affected  part.  They  are  most  use- 
ful in  the  treatment  of  the  various  joint  troubles,  neuralgia, 
neuritis,  and  muscular  affections. 

(1)  Electric-light  (incandescent)  bath. 

(2)  Arc-light  with  reflector. 

(3)  Hot-air  bath. 


REQUISITE   EQUIPMENT    FOR   AN   INSTITUTION  431 

(4)  Hot-air  douche. 

(5)  Hot- water  douches: 

(a)  Simple  hot  douche. 

(6)  Scotch  douche. 

(c)  Alternating  douche. 

(6)  Fomentations. 

REQUISITE  EQUIPMENT  FOR  AN  INSTITUTION 

The  chief  apparatus  is  as  follows: 

(1)  Electric-light  cabinet.  This  is  a  cabinet  or  box  lined 
with  plate-glass  mirrors  and  lighted  with  eight  rows  of  six  in- 
candescent lights. 

(2)  Two  cabinets  for  hot-air  and  vapor  baths. 

(3)  Incandescent  electric-light  bath  for  treating  single  parts 
of  the  body. 

(4)  Arc-light  with  reflector  for  local  treatments. 

(5)  Local  hot-air  bath. 

(6)  Douche-table  with  which  a  large  tank  for  hot  water  and 
a  pressure  pump  is  connected.  The  temperature  and  pressure 
are  controlled  by  valves  and  the  readings  are  easily  made  on 
the  thermometers  and  gauges.  (See  pp.  282  and  283  for  illustra- 
tions.) 

(7)  Circular  douche  or  needle  bath. 

(8)  Rain  douche,  descending,  or  shower-bath. 

(9)  Horizontal  douche,  or  spout : 

(a)  Jet  douche,  single  or  double,  for  Scotch  douche. 
(6)  Fan  douche. 

(10)  Ascending  or  perineal  douche. 

(11)  Sitz-bath. 

(12)  Porcelain  tub  used  for  carbon-dioxid  baths,  half-baths, 
full  baths. 

When  desired,  electric  baths  may  be  given  in  the  tub. 


APPENDIX 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  *- 

By  Simon  Baruch,  M.  D.,  New  York 

The  material  antl  professional  interests  of  the  physician 
have  been  seriously  injured  and  menaced  by  his  neglect  of 
physiologic  remedies.  The  fact  is  demonstrated  by  the  revolu- 
tion in  medical  education  which  the  advent  of  the  Naturarzt 
produced  i!i  Germany,  and  which  I  witnessed  in  1890,  when  the 
priest  Kneipp  was  in  the  zenith  of  his  meretricious  fame. 

In  this  paper  I  shall  advert  only  to  the  remedial  application 
of  water,  which  is  acknowledged  to  be  the  chief  physiologic 
remedy  by  Marcuse  and  Strasser  in  their  new  "Monatschrift 
fuer  die  Physikalisch-diirtetischen  Hcilmethoden." 

For  half  a  century  Winternitz,  of  \'ienna,  had  been  striving 
to  make  hydrotherapy  ''the  common  property  of  the  medical 
profession."  To  this  end  he  had  urged  his  colleagues  to  learn, 
teach,  and  practice  it,  but  his  warnings  and  appeals  remained 
without  effect  until  the  Naturarzt  began  to  menace  the  material 
interests  of  the  German  doctor.  When  this  unexpected  danger 
was  realized,  systematic  efforts  were  inaugiu'ated  to  meet  the 
invasion  of  these  empirics,  who  sprang  up  everywhere,  prompted 
by  the  prospective  harvests.  A  commission  for  the  revision 
of  medical  studies,  with  Professor  Kussmaul  as  chairman,  was 
appointed,  which,  after  due  investigation,  reported  as  follows: 

"There  is  no  doubt  that  trust  in  the  ]:)rescription  is  waning 
among  educated  people  and   that  the  confidence  in  dietetic 

1  Delivered  by  invitation  before  the  Boston  Society  for  Medical  Improve- 
ment, on  Feb.  8,  1909.     Included  by  permis.'sion  of  his  friend,  Dr.  Baruch,  the 
most  distinguished  advocate  of  hydrotherapy  in  America  (Boston  Med.  and 
•Surg.  Jour.,  April  15,  1909). 
432 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  433 

remedies  and  in  the  remedial  value  of  water  is  in  the  ascendant. 
Water  has  especially  won  for  itself  steadily  growing  confidence 
as  a  remedy.  Hydrotherapy  combined  with  diet  may,  un- 
doubtedly, bring  about  or  aid  in  the  cure  of  numberless  acute 
and  chronic  diseases.  Of  hydrotherapy  the  young  physician 
knows  nothing  when  he  leaves  the  university.  Unhappily,  he 
sooner  or  later  may  encounter  discomjiture  luhen  an  uneducated  water- 
doctor  steps  in  and  cures  the  patient  after  he  has  failed.  Herein 
lies  a  great  gap  in  the  education  of  our  physicians.  A  revision 
of  our  course  of  study  must  be  made  above  all  things;  distinct 
chairs  and  clinics  are  demanded,  in  which  appropriate  cases 
may  be  treated  by  hydrotherapeutic  procedures." 

This  brief  extract  from  the  report  of  the  commission  furnished 
clear  proof  of  the  incursion  of  the  quack  upon  the  status  of  the 
medical  profession  in  Germany,  and  pointed  out  the  remedy  in 
emphatic  terms.  The  result  was  remarkable,  for  in  a  very 
short  time  the  principal  German  universities  established  clinics 
for  hydrotherapy  and  other  physical  remedies,  in  which  the 
development  of  physical  therapeutics  began.^ 

Thus  it  has  come  about  that  a  menace  to  material  interests 
speedily  accomplished  that  which  Winternitz  had  failed  to  do 
by  earnest  and  persistent  effort  during  a  half  century.  This 
historic  fact,  which  may  be  corroborated  by  other  proofs,  is 
cited  here  as  a  warning  and  lesson  to  the  medical  profession 
of  our  own  country.     Our  material  interests  have  already  been 

1  During  a  visit  to  Germany  last  spring  I  discovered  that  the  Naturarzt 
is  still  active  despite  the  numerous  well-equipped  clinics  on  hydrotherapy 
and  other  physical  methods.  The  reason  hes,  probably,  in  the  fact,  which 
was  ascertained  by  personal  visits  to  or  correspondence  with  all  the  larger 
universities,  that  attendance  upon  these  clinics  being  optional,  very  few  students 
attended  them.  In  three  -universities  there  were  no  applicants  at  aU  for  in- 
struction in  physical  therapy;  in  one  I  saw  five  students;  and  only  in  Leipzig 
did  I  find  a  respectable  number  obtaining  excellent  instruction  from  Dr. 
Steinert,  the  chief  of  Curschmann's  clinic.  This  obsen/ation  justifies  my 
insistence  upon  obligatory  attendance  of  the  lectures,  of  instruction  of  sec- 
tions, and  of  a  final  examination  as  the  sine  qua  non  of  the  chair  of  hydro- 
therapy in  Columbia  University.  These  conditions  have  been  satisfactorily 
executed,  and  only  in  this  manner  may  the  study  become  practically  useful 
to  student  and  teacher. 
28 


434  HYDROTHERAPY 

seriously  damaged  by  empirics  of  high  and  low  degree — Christian 
Scientists,  osteopaths,  water-cure  doctors,  vibrationists,  and  their 
ilk.  Is  it  not  our  imperative  duty  to  ascertain  the  cause  of 
the  defection  of  our  patient  to  the  empirics? 

It  behooves  us  to  study  and  apply  drugs  less  insistently  and 
to  devote  more  effort  to  a  better  comprehension  of  the  remedial 
action  of  water  and  other  physical  remedies  and  of  those  psychic 
agencies  which  the  lay  doctor  and  empiric  manage  so  success- 
fully. All  these  may  certainly  be  applied  with  more  skill  and 
judgment^  and,  therefore,  with  better  results,  by  the  educated 
physician,  who  thus  may  advance  not  only  his  material  interests, 
but  also  the  more  humane  and  more  lofty  interests  involved 
in  the  amelioration  and  cure  of  disease. 

(1)  That  a  better  understanding  of  the  rationale  of  the  action 
of  water  in  disease  may  lead  to  the  saving  of  life  is  a  proposition 
not  difficult  of  proof. 

Example  1. — For  twenty  years  I  have  endeavored  to  im- 
press upon  my  colleagues  in  this  country  that  in  the  application 
of  the  bath  in  infectious  fevers  the  antipyretic  is  secondary  to  the 
nerve-stimulating  and  sustaining  effect.  Prompted  by  the  fact 
that  many  lives  were  being  sacrificed  by  disregard  of  this  vital 
principle  of  hydrotherapy,  I  spared  neither  sacrifice  of  time  nor 
effort  to  establish  it  by  addresses  delivered  by  invitation  from 
medical  schools  or  societies  in  New  York,  Philadelpliia,  Boston, 
Albany,  Baltimore,  Chicago,  St.  Louis,  Buffalo,  Charleston,  S.  C, 
Richmond,  Va.,  San  Francisco,  and  Los  Angeles,  besides  other 
smaller  cities.  Fear  of  shock  had  long  operated  against  the 
adoption  of  effective  cold  procedures,  because  of  the  erroneous 
antithermic  idea  of  the  cold  bath,  a  fallacy  which  Hippocrates 
combated.  Physicians  had  been  taught  to  increase  the  dose  of 
castor  oil,  morphin,  or  other  medicine  if  they  desired  an  intensified 
effect;  hence  they  naturally  ordered  the  cold  bath  made  colder 
when  the  temperature  did  not  yield.  As  a  result  they  obtained 
depression  from  injudicious  dosage,  and  they  rejected  a  remedy 
which  judiciously  used  would  have  produced  quite  different 
effects. 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  435 

The  cold  bath,  indeed,  every  cold  procedure,  has  for  its  chief 
object  the  enhancement  of  the  resisting  capacity  of  the  patient 
to  the  disease.  In  an  acute  disease  like  typhoid  fever  this  is  ac- 
complished, first,  by  the  well-known  primary  effect  of  cold  in 
contracting  the  cutaneous  vessels.  This  is  followed  by  reaction, 
which  is  manifested  by  a  tonic  dilatation  of  the  vessels,  whose 
walls  had  previously  been  in  a  semiparetic  state  by  reason  of 
the  prevailing  toxemia.  The  heart  is  thus  materially  aided  in 
its  labor  to  overcome  the  unresponsive  condition  of  the  peripheral 
vessels.  Heart  failure,  which  stands  as  a  specter  at  the  bedside 
of  every  case  of  infectious  fever,  is  not  due  so  much  to  enfeeble- 
ment  of  the  cardiac  muscle  by  hyperpyrexia  as  to  the  imperfect 
action  of  the  peripheral  vessels,  which  allows  the  blood  to  glide 
through  them  without  resistance.  Cold  water  applied  with 
friction  stimulates  the  cutaneous  arterioles  to  a  more  nearly 
normal  action;  it  increases  peripheral  elasticity  and  resistance 
and  enables  the  heart  to  renew  its  energy.  Arterial  tension  is 
increased,  the  danger  of  failure  of  the  laboring  heart  is  overcome. 

(2)  The  excitation  of  the  terminal  filaments  in  the  skin 
which  follows  the  repeated  impact  of  cold  water  is  rapidly  con- 
veyed to  the  central  nervous  system  and  thence  reflected  upon 
the  life-maintaining  organs  whose  functions  have  been  more 
or  less  impaired  by  the  existing  toxemia.  Each  bath  or  other 
cold  procedure  gives  a  fillip ,  to  the  depreciated  nerve-centers 
and  sends  new  life  to  the  organs  depending  upon  them.  The 
whole  machinery  of  the  organism  receives  a  refreshing  impetus, 
the  impression  being  more  or  less  enduring  according  to  the 
temperature,  duration,  and  procedure  to  which  the  patient  is 
subjected.  All  this  is  now  recognized  by  the  well-informed 
physician,  and  yet  nearly  every  text-book  refers  to  the  cold  bath 
under  the  caption  of  heat-reducing  agents,  and  few  emphasize 
the  truth  that  the  correct  cold  bath  is  an  antifebrile  remedy  which 
meets  in  fevers  all  therapeutic  indications,  of  which  temperature 
reduction  is  only  one.  A  far  more  important  truth  than  this 
even  still  appears  to  lack  appreciation,  viz.,  that  the  cold  bath 
is  not  a  symptomatic  remedy,  but  that  its  value  is  due  to  the 


436  HYDROTHERAPY 

prophylactic  action  in  infectious  fevers.  It  has  been  clearly 
demonstrated  by  large  bedside  observations  that  the  early  and 
correct  application  of  hydrotherapeutic  procedures  in  fever 
prevents  complications  and  saves  liv(^s  by  r(>moving  from  the 
causes  of  death  heart  failure,  perforation,  hemorrhages,  and 
hypostases.  Upon  the  recognition  of  the  prophylactic  effect 
of  judicious  bathing  begun  in  the  first  week  of  typhoid  fever 
the  Brand  method  is  based,  and  only  to  the  neglect  of  this 
principle  is  due  the  failure  of  the  latter.  That  thousands  of 
lives  have  been  saved  by  the  correct  application  is  evident  from 
Vogl's  statistics,  the  reports  of  the  German  Army,  and  their 
corroboration  in  our  country  by  Peabody,  Wilson,  Loomis, 
Osier,  Thompson,  myself,  and  others.  Dr.  Oilman  Thompson 
states  in  his  Text-book  on  Practice  that  the  mortality  of  ty- 
phoid fever  was  reduced  from  16  to  6  per  cent,  in  the  Presby- 
terian and  in  the  New  York  hospitals,  since  the  introduction  of 
the  Brand  bath,  and  the  late  Dr.  H.  P.  Loomis  reported  to  the 
Practitioners'  Society  of  New  York,  in  1903,  that  the  mortality 
from  typhoid  fever  in  the  principal  New  York  hospitals  had 
been  reduced  50  per  cent,  since  the  introduction  of  the  systematic 
use  of  the  Brand  bath.  Bear  in  mind  that  the  evidence  is 
furnished  by  professors  of  medicine  in  two  large  medical  schools. 
Comparing  the  number  of  deaths  from  this  disease  in  previous 
years,  it  may  be  safely  computed  that  1000  lives  have  been  saved 
in  New  York  City  alone  by  the  correct  application  of  water  in  one 
disease.  If  it  be  borne  in  mind  that  private  practice,  in  which 
bathing  may  be  begun  earlier  than  in  hospitals,  where  patients 
are  brought  in  late  in  the  disease,  offers  a  far  more  favorable 
field  for  this  treatment,  it  becomes  quite  apparent  how  many 
lives  are  sacrificed  by  the  neglect  of  this  procedure. 

Example  2. — ^The  management  of  cases  of  isolation  (heat- 
stroke, sunstroke)  has  been  for  several  decades  by  cold  baths, 
ice-packs,  and  similar  heroic  procedures,  based  on  the  fallacious 
idea  that  temperature  reduction  may  best  be  accomplished  by 
them.  The  loss  of  life  which  was  positively  attributable  to  this 
irrational  practice  will  be  clearly  shown  in  another  part  of  this 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  437 

paper.  Several  hundred  lives  were  sacrificed  in  one  summer 
by  the  neglect  of  the  well-established  principle  of  hydrotherapy 
that  the  coldest  bath  is  not  the  most  antithermic  procedure, 
and  that  the  most  successful  therapy  of  sunstroke  must  be  the 
more  rational  method,  based  upon  stimulation  of  the  nervous 
system,  as  the  chief  therapeutic  indication,  just  as  it  is  in  in- 
fectious fevers. 

Example  3- — In  1892  I  reported  to  the  New  York  State 
Medical  Society  the  striking  results  of  judicious  hydrotherapy 
in  phthisis  pulmonalis,  produced  by  its  favorable  effect  upon 
nutrition  and  hematosis.  In  my  work  on  hydrotherapy  there 
appears  a  record  of  similar  results  observed  by  others  in  large 
numbers,  which  may  be  regarded  as  a  control  therapeutic  experi- 
ment. Dr.  Kuthy,  of  the  great  sanatorium  of  Budapest,  com- 
pares his  results  with  those  of  another  large  institution  at  Belzing, 
near  Berlin.  The  records  show  14  per  cent,  more  restorations 
under  the  mild  systematic  hydrotherapy  of  Budapest  than  under 
the  strong  douches  of  Belzing.  Although  these  statistics  were 
published  several  years  ago,  their  lesson  has  not  yet  been  utilized 
in  American  sanatoria.  I  have  sought  in  vain  for  any  allusion 
to  hydrotherapy  in  the  Tuberculosis  Congress.  Indeed,  I  am 
credibly  informed  that  one  of  our  noted  sanatoria,  where  a 
complete  hydriatric  equipment  was  installed,  and  which  by 
request  I  visited  at  much  sacrifice  of  time  and  trouble  to  instruct 
the  staff  and  nurses,  no  longer  uses  the  apparatus.  Shall  we 
continue  to  be  laggards  in  this  valuable  method  and  withhold 
from  these  desperate  cases  so  valuable  a  means  of  enhancing 
their  resisting  powers? 

The  Remedy. — How  is  the  prevailing  neglect  of  hydrotherapy 
to  be  removed?  To  the  unbiased  inquirer  the  answer  is  simple. 
The  cause  is  ignorance  of  the  physiologic  and  therapeutic  action 
of  water,  and  the  remedy  is  its  removal  by  instruction  in  our 
schools  (as  indicated  in  Kussmaul's  report),  the  study,  however, 
being  made  obligatory,  and  reading  by  the  general  practitioner 
of  works  on  hydrotherapy. 

Until  the  report  of  the  Kussmaul  commission  appeared,  the 


438  HYDROTHERAPY 

Vienna  University  was  the  only  medical  school  in  which  hydro- 
therapy was  taught.  Very  few  physicians,  consequently,  ap- 
plied it  in  practice  outside  of  institutions.  True,  as  in  all  periods 
of  medical  history,  a  few  wise  men  advocated  the  remedial  uses 
of  water  in  recent  times  with  earnestness  born  of  conviction. 
Erb,  Charcot,  and  Semmola,  in  their  respective  countries,  pre- 
scribed it  constantly,  but  unfortunately  their  prescriptions 
lacked  precision,  and  were,  therefore,  empirical. 

In  Ziemssen's  Cyclopedia,  for  instance,  Erb  wrote:  "Among 
the  most  powerful  and  effective  agents  in  our  branch  arc  cold 
and  cool  baths  and  the  water  treatment.  Its  results  in  all 
possible  chronic  nerve  troubles  arc  extraordinarily  favorable." 
Aside  from  these  laudatory  statements,  Erb  offers  no  directions 
to  guide  those  who  would  fain  obtain  the  same  "extraordinary" 
and  "powerful"  results  of  the  "cold-water  treatment."  The 
reason  may  be  found  in  the  fact  that  I^rb  entrusted  his  patients 
to  institution  doctors  who  have  not  transmitted  their  special 
methods  to  us.  The  result  was  a  blind  groping  in  the  dark  and 
consequent  failure,  which  may  be  tlemonstrated  by  numerous 
examples.  Let  me  cite  one  illustration  published  in  the  Inter- 
national Clinics.  A  well-known  neurologist  tells  his  class :  "  The 
best  remedy  for  neurasthenia  is  cold  water  in  the  morning.  Let 
the  patient  stand  in  warm  water  and  with  a  sponge  pour  cold 
water,  or  very  cold  water,  over  his  head,  shoulders,  and  nape  of 
the  neck,  etc."  The  temperature  of  the  cold  and  very  cold 
water,  the  duration  of  the  procedure,  the  friction  needed  for 
feeble  individuals,  the  frequency  of  repetition,  are  not  mentioned, 
and  yet  when  this  professor  comes  to  speak  of  strychnin  and  the 
phosphates  he  becomes  jirecise  in  stating  dose,  form,  and  mode 
of  administration,  etc.  If  specialists  teach  hydrotherapy  so 
vaguely,  the  practitioner  naturally  ignores  this  "powerful," 
"extraordinary"  agent  and  plies  the  patient  with  drugs,  with 
the  appUcation  of  which  he  is  more  familiar.  Failure  and  dis- 
appointment to  physician  and  patient  alike  are  inevitable. 

The  Charcot  douche  has  come  down  to  us  sanctioned  by 
the  great  name  of  the  man  who  applied  it  chiefly  in  hysteria. 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  439 

Does  any  one  know  to-day  the  temperature,  duration,  or  pressure 
Charcot  prescribed  for  this  douche?  All  we  know  is  that  it  is 
a  strong  jet  or  stream  driven  upon  the  spinal  column.  So  far 
as  I  am  informed,  specialists  order  it  generally  without  regard 
to  these  essential  elements  because  the  latter  have  not  been 
transmitted  to  posterity.  A  few  days  ago  I  discovered  type- 
written instructions  in  a  large  hospital  erroneously  describing 
the  Charcot  douche  as  one  of  alternating  temperatures.  Failure 
is  more  frequent  than  success,  as  a  long  connection  with  institu- 
tions has  demonstrated  to  me.  Were  it  not  pathetic,  it  would 
seem  absurd  to  find  an  eminent  neurologist  order  "hot  box  and 
Charcot  douche"  for  most  of  his  cases  of  neurasthenia.  He 
leaves  the  duration  of  the  ''hot  box"  (which  is  the  cabinet)  and 
the  temperature  and  preparation  of  the  douche  to  the  attend- 
ant, who  certainly  knows  less  of  the  physiologic  action  of  water 
than  the  druggist  knows  of  medicines,  and  yet  this  gentleman 
is  so  careful  with  the  latter  that  he  directs  patients  where  to 
obtain  parathyroid  tablets  or  other  important  drugs  which  he 
prescribes.  How  can  the  students  master  the  technic  of  his 
hydrotherapy  if  he  himself  is  so  indefinite  in  its  prescription? 

That  the  most  frequent  result  of  indefinite  prescriptions  of 
water  is  failure,  and  not  rarely  a  change  of  doctors  and  resort  to 
quacks,  has  been  often  demonstrated.  Clearly,  if  the  leaders 
in  medicine  had  themselves  received  the  same  instruction  in 
the  rationale  and  therapeutics  of  water  which  was  given  them 
in  drugs,  they  would  have  taught  hydrotherapy  as  they  teach 
drug-therapy;  the  young  practitioner  would  not  find  himself 
in  the  sad  plight  depicted  by  Kussmaul;  he  would  be  armed 
with  a  powerful  weapon  against  disease  and  quackery. 

In  the  present  status  of  this  subject,  the  judicious  practitioner 
would  act  wisely  to  altogether  dispense  with  water  in  thera- 
peutics unless  he  be  at  least  as  familiar  with  its  action  as  he  is 
with  the  effect  of  medicinal  agents,  or  is  able  to  obtain  counsel 
on  its  application.  The  former  is  not  as  difficult  as  it  would 
appear  from  the  vague  mention  of  baths,  packs,  drip  sheets, 
in  books  of  reference.     The  average  text-book  must  he  avoided  by 


440  HYDROTHERAPY 

the  seeker  oj  knowledge  in  hydrotherapy.  It  \vcre  an  act  of  inex- 
cusable temerity  on  my  part  to  make  this  statement  did  not  the 
facts  warrant  it  and  the  occasion  demand  it.  Text-books  on 
therapeutics  and  practice  in  every  language  may  be  cited  as 
j)roof  of  the  utter  unreliability  as  guides  in  the  application  of 
water  in  disease.     Let  me  offer  a  few  examples: 

(a)  In  a  recent  vade  mecum  of  therapeutics,  translated  from 
the  German,  and  popular  among  Italian  physicians,  the  trans- 
lator mentions  in  his  otherwise  valuable  annotations — impacchio 
umido — the  wet  pack  around  the  trunk  as  valuable  in  pneumonia. 
^Mlether  this  wet  pack  is  to  be  cold,  warm  or  hot,  its  frequency, 
duration,  and  mode  of  application — these  are  left  to  the  fancy 
of  the  doctor  who  consults  this  otherwise  valuable  book  for 
guidance. 

(/>)  In  a  paper  on  pneumonia  of  children  read  before  a 
medical  society  and  published  in  the  Archives  of  Pediatrics,  an 
eminent  pediatrist  states:  "When  the  temperature  is  103°,  104°, 
105°,  or  106°  F.  (39.4°,  40°,  40.5°,  or  41.1°  C.)  I  apply  cold  baths 
and  cold  packs.  Cold  water  is  the  best  antipyretic."  The  fact 
that  cold  water  means  water  from  the  cold  faucet,  and  the  more 
important  truth,  that  tejnd  water  is  a  better  antipyretic  than 
cold  water,  are  entirely  disregarded.  Cold  water  ranges  from 
35°  to  75°  F.  (1.6°-23.9°  C.)  as  it  comes  from  the  "cold"  faucet 
at  different  seasons  and  in  different  countries.  The  wise  prac- 
titioner would  do  well  to  avoid  even  baths  of  75°  F.  (23.9°  C.) 
in  the  pneumonia  of  children.  Although  the  temperature  and 
technic  of  the  cold  baths  and  packs  which  the  eminent  pedi- 
atrist recommends  are  not  regarded  by  him  as  worthy  of  men- 
tion, his  diregtions  for  the  preparation  and  dosage  of  his  favorite 
drugs  are  emphasized  minutely.  He  ingenuously  admits,  too, 
that  he  was  asked  to  resign  from  a  hospital  on  account  of  his 
predilection  for  cold  baths. 

(c)  In  an  excellent  English  work  on  the  "Action  of  Medicines," 
which  has  been  a  text-book  in  many  American  schools,  the 
"cold  bath"  is  referred  to  among  "the  best  antipyretics,"  and 
its  technic  described  as  a  bath  of  65°  F.  (18.3° C),  reduced  by  ice 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  441 

to  40°  F.  (4.4°  C);  the  patient  lying  in  this  bath  until  his  tem- 
perature is  reduced !  The  lecturer,  fortunately,  insists  on  guard- 
ing against  collapse,  which  would  be  equivalent  to  a  recom- 
mendation of  dangerous  doses  of  strychnin  with  a  warning  to 
watch  for  opisthotonos.  Not  a  word  is  said  of  friction,  the 
most  important  element  of  all  cold  baths,  and  the  physiologic 
fact  that  such  a  bath  would  increase  the  body  temperature  instead 
of  reducing  it,  as  has  been  demonstrated  by  Liebermeister  and 
others,  is  lost  sight  of  by  an  author  whose  greatest  merit  is  the 
rational  basis  of  his  therapeutic  teaching. 

(d)  Another  very  popular  American  text-book  on  therapeutics 
displays  ignorance  of  what  any  one  in  hydrotherapy  would 
know  by  stating  that  "&  douche  falhng  more  than  10  feet  is 
neither  proper  nor  safe."  I  have  seen  thousands  of  douches 
administered  with  water  that  fell  60  feet,  and  in  our  own  institu- 
tion here  you  may  observe  that  so  feeble  a  douche  is  never  used. 
The  absurdity  of  this  author's  warning  is  obvious,  and  serves  to 
illustrate  my  proposition  that  even  the  best  text-books  are  false 
guides  on  hydrotherapy. 

(e)  A  work  on  the  treatment  of  nervous  diseases  describes 
the  drip  sheet  as  a  sheet  wrung  out  of  cold  water.  The  tautology 
is  self-evident  and  proves  a  lack  of  practical  acquaintance  with 
hydrotherapy,  and  that  the  author  has  simply  copied  from  other 
faulty  works. 

Most  text-books  on  practice  of  medicine  are  equally  unre- 
liable as  guides  in  the  use  of  water  in  disease. 

There  exists  a  want  of  unanimity  and  absence  of  definite 
instruction  in  the  description  and  effect  of  hydrotherapeutic 
procedures,  if  these  are  mentioned  at  all,  among  authors  which 
is  in  striking  and  painful  contrast  to  their  universal  agreement 
upon  the  application  and  dosage  of  drugs  and  other  remedial 
agents.  This  absence  of  precision  naturally  intimidates  the 
physicia.n  who  consults  these  works,  and  imbues  him  with  the 
idea  that  water  is  inferior  to  drugs.  Moreover,  while  the  other- 
wise able  and  conscientious  authors  keep  abreast  of  the  progress 
of  their  subject   in   all   other  respects,  they  appear  to  ignore 


442  HYDROTHERAPY 

the  most  reliable  conti'ibutions  to  the  literature  of  the  water 
treatment.  One  example,  briefly  referred  to  already,  may 
suffice  to  prove  this  statement.  In  1897  Dr.  Alexander  Lambert, 
of  Belle^ale  Hospital,  New  York,  read  before  a  medical  society 
and  published  in  the  Medical  News  a  paper  containing  the  largest 
modern  statistics  on  sunstroke.  These  were  gathered  from 
hospital  records,  read  before  a  medical  society  and  published  in 
a  prominent  medical  journal;  the  number  of  cases  treated  by 
each  method  and  the  results  were  clearly  stated,  and  their  simi- 
larity of  type  is  established  by  their  simultaneous  occurrence  in 
one  week.  The  mortality  under  the  graduated  bath  of  110°  to 
72°  F.  (43.3°-22.2°  C.)  in  the  Brooklyn  Homeopathic  Hospital 
was  41.17  per  cent.;  the  mortality  under  ice-baths  (Bellevue 
Hospital)  was  33.33  per  cent. ;  under  affusions  and  douches  with 
water  at  prevailing  temperature,  70°  F.  (21.1°  C),  in  theFlower 
Homeopathic  Hospital,  was  11  per  cent.  The  remarkable  fact 
is  also  mentioned  that  when  the  bath  treatment  in  the  Brooklyn 
Homeopathic  Hospital  was  changed  to  the  more  rational  afTusion 
practised  in  the  Flower  Hospital,  the  mortality  was  at  once 
reduced  to  11.5  per  cent.  In  the  St.  Vincent  Hospital  the  late 
Dr.  O'Dwyer  obtained  still  more  favorable  results  by  simple 
affusions  with  cold  water  from  the  cold  faucet,  and  in  severe 
cases  with  ice- water,  a  procedure  recommended  thirteen  hundred 
years  ago  by  Paulus  ^Egineta  as  the  only  rational  practice.  The 
mortality  in  197  hyperpyrexia!  cases  was  6  per  cent. 

This  valuable  report  really  affords  a  control  experiment  unsur- 
passed in  therapeutics.  Nor  have  I  noticed  any  reference  to  the 
latter  in  the  numerous  works  of  practice  which  I  have  searched 
for  this  purpose  in  the  library  of  the  New  York  Academy  of  Medi- 
cine; they  all  reiterate  the  dreary  platitudes  about  the  import- 
ance of  reducing  the  temperature  by  the  cold  bath,  by  ice-packs, 
ice-baths,  and  similar  irrational  procedures.  If  such  a  report  had 
brought  forward  the  fact  that  a  medicinal  agent  had  so  greatly 
reduced  the  mortality  of  a  fatal  disease,  these  text-books  would 
not  have  omitted  to  mention  it,  with  the  most  earnest  approval. 
No  more  convincing  proof  can  be  adduced  to  demonstrate  the 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  443 

utter  unreliability  of  the  text-books  on  practice  as  guides  in 
the  application  of  water  in  disease,  nor  of  the  importance  of  its 
correct  and  rational  use.  How  the  false  teaching  of  the  text- 
books is  perpetuated  is  demonstrated  in  the  New  York  Medical 
Journal,  which  last  spring  (1908)  offered  a  prize  for  the  best 
article  of  the  treatment  of  sunstroke.  Not  a  single  one  of  the 
writers  of  this  essay  referred  to  the  report  of  the  epidemic  of 
1896,  in  which  numerous  lives  were  lost  by  sunstroke,  most  of 
which  would  no  doubt  have  been  saved  by  correct  management. 

How,  then,  it  may  be  asked,  is  the  active  practitioner  to 
obtain  rehable  information  on  hydrotherapy  if  the  standard 
works  of  reference  do  not  furnish  it?  Here  he  meets  a  difficulty 
which  I  propose  to  aid  in  surmounting.  All  of  the  special  works 
on  hydrotherapy  have,  until  recently,  been  written  by  water- 
cure  doctors,  whose  observations  are  chiefly  on  chronic  diseases 
and  who  rarely  see  fevers  and  other  acute  maladies  in  which 
water  is  a  very  important  and  accessible  therapeutic  agent. 
Nor  does  the  institution  doctor  have  sufficient  opportunity  to 
observe  the  incipient  stages  of  chronic  cases,  which  are  the  bane 
of  the  family  physician,  who,  when  he  consults  these  special 
works,  seeks  in  vain  for  precise  directions  for  his  guidance,  and 
only  after  failure  to  restore  the  sufferer  to  health  sends  him  or 
her  to  a  sanatorium,  if  a  quack  or  Christian  Scientist  be  not 
resorted  to  by  the  family  before  he  determines  to  do  so. 

As  a  general  practitioner  I  long  ago  realized  this  difficulty 
in  my  early  efforts  to  follow  the  French  and  German  special 
works.  They  led  me  to  many  failures  because  their  methods 
were  too  heroic,  not  clearly  individualized,  and  not  adapted  to 
private  practice. 

There  is  but  one  recourse  that  insures  the  practitioner  against 
such  disillusion  and  failure,  i.  e.,  to  depend  only  on  works  written 
by  physicians  who,  like  himself,  have  experience  in  general  or 
hospital  practice.  They  alone  are  capable  of  appreciating  his 
utter  helplessness  when  confronted  with  cases  in  which  water 
has  been  successfully  applied.  Happily  there  are  now  several 
works  of  this  type  published  in  German  and  English.     In  these 


444  HYDROTHERAPY 

treatises  hydrotherapy  is  not  vaunted  as  a  specific,  but  as  a 
methotl  of  treatment  which  aids  in  sustaining  the  failing  functions 
and  thus  prevents  fatal  complications  in  acute  disease,  and  which 
furthers  nutrition  and  tissue  change,  the  chief  therapeutic  aims 
in  chronic  disease.  Such  works  contain  simple  directions  for 
home  treatment,  which  in  many  cases  suffice,  and  in  obstinate 
cases  prepare  them  for  institution  treatment,  and  thus  shorten 
the  latter. 

The  study  of  hydrotherapy  would  be  simplified  were  it  re- 
garded as  a  method  of  utilizing  the  physiologic  action  of  thermic 
excitation  through  the  medium  of  water.  The  rationale  of  this 
thermic  excitation,  conveyed  by  water  to  the  ner.ves  and  vessels 
of  the  skin,  explains  all  hydrotherapeutic  procedures,  and  its 
comprehension  and  application  is  not  more  difficult  than  are 
similar  facts  in  the  study  of  drugs.  The  varying  effects  of  vary- 
ing temperature,  duration  and  pressure,  and  technic  afford 
greater  latitude  in  "dosage"  than  do  the  effects  of  drugs,  and 
require  more  detailed  study.  That  the  latter  is  not  difficult, 
however,  must  be  evident  to  every  general  practitioner  who 
utilizes  it  empirically  in  the  management  of  the  stillborn  infant. 
Sprinkling  with  cold  water  is  the  first  and  mildest  procedure; 
if  this  does  not  act  efficienth^  he  dips  the  infant  alternately  into 
hot  and  cold  water;  this  is  a  larger  "dose."  He  docs  not  apply 
a  cold  bath  to  the  stillborn  infant  because  it  would  be  too  large 
a  dose,  nor  a  cold  dip  to  the  typhoid  patient  because  it  would 
be  too  small  a  dose  of  thermic  excitation  to  arouse  flagging 
vitality.  There  is  no  time  in  the  obstetric  case  to  ascertain 
exact  temperature;  the  emergency  must  be  met  and  the  case  is 
immediately  terminated.  In  the  typhoid  patient,  on  the  con- 
trary, many  weary  days  must  be  spent  in  adapting  the  thermic 
excitation  to  the  individual  case,  and  exact  temperature,  dura- 
tion, and  technic  are  of  vital  importance.  The  latter  applies  to 
other  infectious  diseases  and  to  chronic  and  subacute  cases  of 
prolonged  duration.  It  is  only  necessary  to  abolish  the  words 
"cold  water"  and  "hot  water"  and  substitute  thermometric 
designations  and  the  watch  to  convert  haphazard  and  disappoint- 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  445 

ing  into  a  scientific  and  successful  hydrotherapy.  Nothing  is 
more  simple  in  medicine,  and  yet  our  otherwise  more  competent 
writers  indulge  in  vague  and  discouraging  generalities,  if  not 
absurdities,  when  referring  to  water  in  therapeutics,  as  I  have 
endeavored  to  show. 

A  change  is  urgently  demanded  if  we  would  fulfil  the  measure 
of  our  duty  to  our  patients  and  to  ourselves. 

The  capacity  of  water  to  produce  numerous  therapeutic 
effects — stimulant,  tonic,  sedative,  antipyretic,  diaphoretic,  diu- 
retic, depurative,  and  evacuant — has  led  narrow  men  to  erect  a 
medical  system — hydropathy.  Being  based  on  the  fallacy  that 
water  is  a  specific  curative  agent,  it  failed,  and  is  now  the  recourse 
of  empirics  who  vaunt  their  successes,  but  are  silent  on  their 
failures. 

I  would  fain  arouse  more  attention  to  the  vital  fact  that 
physicians  are  not  only  suffering  material  loss  by  neglecting 
hydrotherapy,  but  that  in  their  efforts  to  ameliorate  and  cure 
disease  they  are  sadly  handicapped  by  not  applying  it  frequently. 

My  colleagues,  you  are  favored  in  this  city  by  having  at  your 
disposal  an  institution  which  is  ideal  in  that  it  is  controlled  by 
your  own  colleague  and  not  owned  and  conducted  by  one  whose 
commercial  instincts  would  subordinate  the  best  interests  of 
your  patients  to  his  own  personal  advantage.  Another  in- 
estimable advantage,  as  I  have  learned,  lies  in  the  fact  that 
physicians  are  permitted  and  invited  to  observe  the  treatment, 
just  as  they  are  wont  to  do  in  acute  cases,  under  trained  attend- 
ants. Such  observations  would  convey  to  you  a  large  fund 
of  knowledge  which  must  inure  to  you  and  your  patient's  benefit. 
The  time  demanded  for  thus  watching  a  case  is  trivial,  because 
in  chronic  cases  the  effect  of  hydriatric  measures  is  slow,  and  if 
personal  observation  is  inconvenient,  reports  from  the  trained 
attendant  would  place  you  in  possession  of  the  reactive  capacity 
of  the  patient,  his  gain  or  loss  in  weight,  etc.  You  thus 
would  obtain  a  guide  for  the  renewal  of  prescriptions,  and  add 
valuable  material  to  the  history  of  each  case  so  treated. 

It  may  interest  you  to  obtain  an  outline  of  my  mode  of 


446  HYDROTHERAPY 

prescribing  institution  treatment.  For  cases  of  defective  nutri- 
tion or  hematosis,  idopathic  or  as  a  complication,  the  following 
has  served  me  well : 

I?.  Hot-air  bath  until  warm,  followed  by  circular  douche,  one  minute,  95°  to 
90°  F.  (35°-32.2°  C);  pressure,  20  pounds;  followed  by  fan  douche  for 
one-half  minute  at  85°  F.  (29.4°  C),  reduced  daily  1  degree;  fol- 
lowed by  drj'injj  and  friction,  same  pressure.  Report  after  three  treat- 
ments reaction  and  weight. 

This  prescription  may  be  abbreviated  as  follows: 

l^.    H.  A.  B.  w. 

C.  D.,  one  m.,  95°  to  90°  F.  (35°-32.2°  C),  20  lb. 

F.  D.,  one-half  m.,  85°  F    (29.4°  C),  20  lb. 

Fr. 
No.  3. 

For  a  case  of  obesity,  chronic  rheumatism,  gout,  or  other 
malady  demanding  enhancement  of  tissue  change,  the  prescrip- 
tion may  read : 

I^.    Hot-air  bath,  p.  ten  min.  fto  perspire  ten  minutes). 

Circular  douche,  one  m.,  100°  to  95°  F.  (37.7°-35°  C). 

Fan  douche,  one  m.,  95°  to  85°  F.  (35°-29.4°  C). 

By  these  cautious  procedures  the  patient  may  be  gi'adually 
restored  to  health,  and  the  physician,  observing  the  effect  of  each 
series  of  treatment,  may  increase  their  number  and  intensity 
according  to  indications  in  each  case. 

In  conclu.«ion.  I  desire  to  emphasize  the  fact  that  my  observa- 
tions on  the  effect  of  water  in  disease  have  been  made  at  the  bed- 
side of  private  patients  and  in  the  wards  of  hospitals  for  a  period 
extending  over  a  quarter  of  a  century.  In  a  few  months  I  shall 
pass  the  half-century  mark  of  my  professional  career.  During 
the  first  half  of  the  period  I  was  ignorant  of  the  therapeutic  value 
of  water;  during  the  latter  half  I  have  endeavored  to  study  and 
utilize  it.  Looking  back  upon  this  large  field  of  clinical  observa- 
tion I  am  impelled  to  ofTer  its  results  for  the  furtherance  of  the 
interests  of  the  profession  I  love  and  honor.  Imbued  solely  by 
this  thought,  and  without  hope  or  expectation  of  material  benefit, 


SOME  TRUTHS  ABOUT  HYDROTHERAPY  447 

I  come  to-night,  my  colleagues  of  Boston,  to  bring  to  you  the 
message  that  no  agent  in  the  entire  materia  mcclica  has  so 
often  demonstrated  to  me  at  the  bedside  such  life-saving  prop- 
erties and  afforded  me  such  comfort  and  satisfaction  as  has 
the  correct  application  of  water  since  I  abandoned  the  false 
teachings  imbibed  from  faulty  works  on  hydrotherapy.  In  acute 
diseases  this  was  not  difficult,  because  the  patient  was  under 
the  observation  of  trained  nurses,  change  of  technic  could  be 
readily  made,  and  the  effect  observed  and  recorded.  In  this 
manner  I  was  led  to  abandon  Liebermeister's  heroic  cold  bathing 
and  Ziemssen's  prolonged  cold  baths  in  favor  of  Brand's  brief, 
sustaining  baths;  the  management  of  pneumonia  by  compresses, 
which  have  afforded  me  the  best  results,  also  was  an  evolution 
from  more  heroic  cold  full  baths. 

From  close  study  and  observation  of  the  effect  of  the  heroic 
procedures  recommended  by  Duval,  Keller,  Beni-Barde,  and 
others  in  chronic  diseases  in  the  Montefiore  Home  was  evolved 
my  method  of  neurovascular  training  (The  Principles  and 
Practice  of  Hydrotherapy,  published  by  William  Wood  and  Co., 
1908,  p.  436),  which  improves  nutrition  and  hematosis  and  pre- 
pares the  patient  without  shock  for  more  intense  procedures 
adapted  to  the  furthering  of  tissue  changes. 

Gentlemen,  if  I  have  succeeded  in  impressing  upon  you  the 
crying  need  of  the  obligatory  study  of  hydrotherapy  in  our 
medical  schools,  and  the  enormous  import  of  the  study  and 
more  frequent  utiHzation  of  hydrotherapy  and  other  physical 
measures,  and  if  I  have  succeeded  in  removing  from  your  minds 
some  of  the  misconceptions  which  have  crept  into  this  subject, 
and,  above  all,  if  I  have  convinced  you  that  the  grasp  of  this 
subject  presents  no  difficulty,  but,  on  the  contrary,  that  the 
action  of  water  in  disease  is  based  on  rational  principles,  I  shall 
congratulate  myself  on  adding  to  the  sum  total  of  knowledge 
for  the  alleviation  of  human  suffering. 


44S 


HVDHOTHERArY 


ELECTRIC   PAD,   OR   THERMOPHORE 

This  electric  device  is  an  aid  in  many  hydrotherapeutic  pro- 
cedures.* The  pad  consists  of  a  special  fabric  into  which  German 
silver  resistance  wire  is  interwoven,  the  whole  being;  covered 
with  mackintosh  or  cidonlown.  The  pad  is  provided  with  a  coil, 
plug,  and  rheostat  switch.  In  use  it  is  only  necessary  to  screw 
the  plug  into  a  lamji  socket.  A  turn  of  the  switch  makes  the 
connection,  and  by  adjustment  of  the  switch  the  current  may  be 
varied  in  intensity  in  the  ratio  of  1,  2,  and  4. 


Fig.  145. — The  thermophore. 

The  No.  1  heat  is  designed  for  simple,  moderate  heating 
effects,  as  for  bed  warming,  for  maintaining  the  heat  of  a 
poultice,  or  to  secure  the  effects  of  Bier's  method.  At  this  heat 
the  current  can  be  run  continuously  for  hours  without  overheat- 
ing the  pad.  When  a  higher  form  is  employed,  however,  a  much 
higher  degree  of  heat  is  generated,  such  as  is  required  to  produce 
the  intense  effects  of  a  fomentation  or  cause  general  perspiration. 
When  these  heavier-  currents  are  employed  the  pad  must  be 
exposed  occasionally  so  as  to  prevent  the  excessive  accumula- 
tion of  heat. 

When  effects  itlentical  with  those  of  a  fomentation  are 
required,  a  moist  cloth  is  laid  over  the  skin,  over  this  a  dry 
cloth,  and  upon  this  the  thermophore.  The  thermophore  has 
the  advantage  over  the  fomentation,  the  hot-water  bag,  and 
similar   forms   of  heating  in  that  the   temperature    gradually 

^  Designed  and  manufactured  by  the  Modern  Medicine  Co.,  Battle  Creek, 
Michigan. 


ELECTRIC   PAD,   OR  THERMOPHORE  449 

rises  instead  of  lowering.  The  fomentation  cools  off  so  rapidly 
that  it  must  be  renewed  every  few  minutes,  whereas  the  electric 
thermophore  requires  but  a  single  application  and  may  be  con- 
tinued as  long  as  desired.  ^Vhen  the  heat  becomes  too  gi'eat  to 
be  borne,  it  is  only  necessary  to  adjust  the  switch  so  as  to  employ 
less  current,  and  thus  the  application  may  be  continued  without 
interruption. 

Less  than  one  minute  is  required  to  bring  the  pad  to  the  full 
heat. 

The  expense  is  only  that  of  a  16-candlepower  lamp  light, 
while  the  convenience  is  much  greater  than  with  the  hot-water 
bottle,  clay  poultices,  hot-air  apparatus,  or  other  of  the  dirty,  in- 
convenient, and  cumbersome  apparatus  so  commonly  employed. 

For  ordinary  use  the  pad  is  made  either  with  or  without  the 
regulating  switch.  The  single  heat  pad  answers  very  well  for 
ordinary  purposes,  as  the  heat  can  be  turned  off  and  on  as 
desired. 

ELECTRIC  THERMOPHORE  BLANKET 

These  blankets  are  made  upon  the  same  principle  as  the 
electric  thermophore  described  above.  They  constitute  a  most 
convenient  means  for  making  a  general  application  of  heat. 
They  are  made  with  regulating  switch,  so  that  any  degree  of 
heat  required  may  be  employed. 

29 


INDEX 


Abbreviations  used  in  prescriptions, 

421 
Abdominal  compress,  249 

douche,  256 
Abilena  water,  203,  413 
Ablution,  246 
Accidents  in  hydrotherapy,  386 

in  Turkish  bath,  296 
Acne,  cold  douches  for,  2o4 
Adenitis,  cold  compresses  for,  86 
iEdepsos,  springs  of,  375 
Aerated  waters,  388 
Affusions,  244,  287 
Aix  douche,  129,  263 
Aix-la-Chapelle,  128,  198,  199,  414 
Aix-les-Bains,  125,  205,  264 
Albu  on  spastic  constipation,  152 
Albuminuria  caused  by  cold  baths,  45 

diaphoresis  for,  113 
Alcohol  in  Brand  baths,  61 

in  cerebrospinal  meningitis,  89 

in  pneumonia,  101 

rub,  251 
Alcoholism,  149 

Fleury  douche  in,  281 
AlkaUne  baths,  204,  309 
in  leprosy,  206 

calcareous  waters,  405 

waters,  403 
Alternate  douche,  256 
Alum  in  iron  waters,  415 
Amenorrhea,  warm  bath  for,  291 
Anders,  135,  312 

on  Brand  baths  in  typhoid  fever, 
62 
Anemia,  158 

and  chlorosis,  Turkish  bath  for,  298 


Anemia,  cold  douches  for,  254 
prescription  for,  446 

Nos.  1,  2,  3,  and  7,  422 
sea-bathing,  380 
Angina  pectoris,  53,  291,  428 
Nauheim  treatment,  140 
Apenta,  184,  413 
Apollinaris  water,  410 
Appendicitis,  158 
Arkansas  Hot  Springs,  analysis,  19 
radio-active,  391 
syphiHs,  202,  204 
Arsenic  iron  waters,  415 

not  absorbed  by  the  unbroken  skin 
in  baths,  22 
Arsenical  poisoning,  149 

waters,  204 
Arterial  degeneration,  189 
tension  in  Nauheim  baths,  48 
lowered  by  Aix  douche,  271 
Arterioles,  435 
Arteriosclerosis,  53,  114,  147 
Arthritis  deformans,  131 

treated  by  douches,  281 
gonorrheal,  130 
prescriptions,  Nos.  8,  18,  423 
treatment  at  Aix,  272  ' 
urica,  127 
Ascending  douche,  258,  262 
Ascites  a  coiuiterindication  to  water 

drinking,  401 
Ashley's  Bromin-arsenic  Spring,  N.  C, 

415 
Ashton,  W.  E.,  221 
Asphyxia  neonatorum,  108 
Asthma,  110 
cardiac,  428 

451 


452 


INDEX 


Asthma,  half-bath,  243 

Atheroma,  291 

Atlantic  City,  sea-bathing,  378,  379 

Atonic  congestion,  30 

Atrophy,  secondary  muscular,  122 

Aufrecht  on  cerebro.spinal  meningitis, 

88 
Avicenna  on  cold  baths  for  tetanus, 

89 

Bacterial  toxins  elimination,  47 
Bad  Gastein,  390 
Baden,  128,  414 

Baden,  113 

mud  baths,  333 
Baker  on  insanity,  176 
Baldwin  on  mental  effects,  42 
Ballston  Spa,  N.  Y.,  407 
Balneology  alhed  to  hydrotherapy,  18 
Baltimore  houses  with  bath-tubs,  377 
Bandler's  Medical  Gynccologj',  221 
Banting  on  obesity,  400 
Bareges,  128,  205,  414 
Barron  continuous  bath,  290 
Baruch,  234 

hydrotherapeutic  law,  37 

instruction  in  hydrotherapy,  383 

on  baths  for  tuberculous  patients, 
96 

on  cold  rubs  in  nephritis,  116 

on  eclampsia,  118 

on  educational  bath,  163 

on  epilepsy,  182 

on  heat  and  cold  as  irritants,  35 

on  some  truths  about  hydrotherapy, 
432 

on  sunstroke,  92 

preface,  23,  29 

public  rain  baths,  375 

tub  for  Brand  baths,  64 
Basch,  von,  49 
Bath,  England,  205,  406 
action  of  waters,  20 
Baths,  237 

public,  372 

Roman  and  Greek,  372 
Battaglia,  Italy,  mud  baths,  333 


Baudelocque,  289 

Bear  Lithia  Water,  417 

Beard  on  routine  methods,  44 

Bedford  Alum  Spring,  415 
Springs,  Pa.,  406 

Bed-sores,  218 

continuous  bath  for,  288 

Bellevue  Hosjiital  sunstroke  statistics, 
442 

Belzing  on  tuberculosis  statistics,  437 

Beneke  on  sea-baths,  113 

lieni  liarde,  102,  281,  447 

Bergell  and  Bickell  on  radio-activity, 
412 

Berlin  course  in  hydrotherapy,  385 

Berthollet  apparatus,  Aix,  269 

Bibliography,    Surgeon-general's    Li- 
brary', 17 

Bidet,  165 

Bielefeld,  181 

Bier  method  lowers  heat  production, 
41 

Bilin  water,  418 

Binswanger  on  epilepsy,  180 

Bitter  waters,  413 

Bladder,  neuroses  of,  166 

Blood,  effect  of  baths  on,  56 

Blood-pressure,  effects  of  baths  on, 
31,  48 
of  Nauheim  baths  on,  48,  429 
of  salt  baths  on,  31 
increase  of,  53 

Blood-serum  concentrated  by  excess- 
ive use  of  water,  401 

Blue  Lick,  Kentucky,  407 

Bocklet  Iron  Spring,  415 

Boils,  209 

Bones  and  joints,  diseases  of,  211 

Boston  Medical  Baths,  421,  445 

Bouillons,  269 

Bovaird,  135,  144 

Bowers  on  insanity,  173 

Brain  tumor,  183 

Bran  bath,  208 

Brand,  235 

bath,  60,  436,  447 
effects  on  urine,  45 


INDEX 


453 


Brehmer  on  ice-bags  for  hemoptysis, 

99 
Bridge  on  hot  bath,  239 
Brieger  course  in  hydrotherapy,  385 

on  sciatica,  185 
Broadbent  on  insomnia,  166 
Bromin  waters,  416 
Bronchitis,  108,  400 
Bronchopneimaonia,  107,  400 
Brown,  Lawrason,     on     bathing     in 

tuberculosis,  97 
Brown,  Phihp  K.,  312 

on  Nauheim  baths,  318 
Brown-Sequard  paralysis,  189 
Brozon  oxygen  bath,  323 
Brunton  on  effect  of  heat  and  cold, 
211 

on  sphygmographic    tracings,    51, 
52 
Bubo,  220 
Buffalo  Water,  417 
Bulkley  on  psoriasis,  205 

on  treatment  of  syphihs,  198 
BuUot  on  experiments  with  distilled 

water,  398 
Burns  and  scalds,  215 

continuous  bath  for,  288 
Buxbaum,  235 

half-baths  in  pneumonia,  103 
Buxton,  276 

England,  205 

for  arthritis,  130 

for  gout,  129 

moor  baths,  334 

radio-activity,  391 

Cabinet  baths,  125 
Calcareous  waters,  406 

baths  in,  24 
Calcium  salts,  405 
Caledonia  Springs,  Canada,  407 
CaUfomia  Coronado,  378 

sea-bathing,  378 
Camac,  312 

Capillaries,  role  in  reaction,  29 
Carabana  water,  413 
CaracaUa,  baths  of,  372 


Carbon  dioxid,  exhalation  of,  in  cold 

baths,  38 
Carbonated  baths,  310 

drinking  waters,  397 
Carles  on  sea- water  injections,  411 
Carlsbad,  19,  407 

conditions  at,  133 

mud  baths,  333 

visitors  to,  388 

water,  404 
Castahan  Springs,  California,  413 
CataboHsm  due  to  cooling,  39 
Catarrhal  fever,  110 
Cauterets,  128,  414 
Cerebrospinal  meningitis,  87 

warm  baths  for,  291 
Chalybeate  baths,  159 
metabolism  of,  36 

(steel)  waters,  415 
Chamberlen  on  public  baths,  375 
Charcot,  438,  439 

douche,  255 
Chatel-Guyon,  double  current  irriga- 
tion apparatus,  369 

douche,  183 
Cheltenham,  England,  407,  415 
Chemic  analysis  of  waters,  18,  19,  24 

stimuH  raise  heat  production,  41 
Chicago  course  in  hydrotherapy,  384 
Children,  baths  for,  93 
Chlorid  retention,  409 
Chlorosis,  158 
Cholera,  hot  baths,  90 

infantum,  157 
Chorea,  87 

Christian  on  chlorid  retention,  409 
Circular  douche,  251 
Clark's  Riverside  Spring,  Mich.,  413 
Claytor,  T.  A.,  322 

on  orthodiagraph,  146 
Cleansing  effect  of  baths,  24* 
Clifton  Springs,  N.  Y.,  406 

for  gout,  129 
Clothing,  27 

Clow,  J.  B.,  and  Sons,  284,  285 
Cohen,  S.  S.,  123,  312 
Cold  and  heat,  effects  of,  24 


454 


INDEX 


Cold  applications  for  nephritis,  116 
bath,  238 

and  heart,  322 
and  metabolism,  34 
danger  of,  in  sunstroke,  436 
fear  of,  434 
in  typhoid  fever,  67 
in  rheumatism,  124 
douche,  253 
in  pneumonia,  100 
in  tetanus,  89 
pack  in  scarlet  fever,  81 
in  typhoid  fever,  76 
water  coil  illustrated,  102 
meaning  of,  440 
Colonic  irrigation,  359 
Colorado  waters,  radio-active,  391 
Columbia  I'niversity,    instruction    in 

hydrotherapy,  383,  433 
Compresses,  344 
cold,  346 
ice,  347 
Conde  Spa  iron  water,  416 
Congestion  of  lung,  109 
Congress  water,  98 
Constipation,  151 

chronic,  sea-bathing  for,  380 
douche-massage  for,  277 
prescription  for,  No.  10,  423 
Continuous  baths,  169,  287 

for  burns,  215 
Contrexeville,  406 
Control  table,  164,  281 
Convalescence,  158 
Convulsions  of  children,  89 
Cook,  Henry  W.,  on  hypertension,  53 
Corbin  douche,  269 
Cornet's  method  of  bathing  in  tuber- 
culosis, 94 
Corson,    on    treatment    of    measles, 
79 
of  typhoid,  00 
Cough,  compress  to  chest  for,  98 
Counterindications  to  baths,  53 
to  Brand  baths,  70 
to  cold  full  baths,  240 
Crab  Orchard  "Water,  184,  203,  413 


Craig  Colony  at  Sonyea  for  epileptics, 

168,  180,  182 
Cramps,  muscular,  381 
Crenology,  388 

Crockett's  Arsenic  Spring,  415 
Crofton  on  sweating  in  renal  disease, 
112 

treatment  of  chronic  nephritis,  115 
Crook    on    constituents    of     waters, 

417 
Cross-binder,  99 
Crounotherapy,  388 
Croyden  bath,  315 
Curie,  M.,  412 

on  radio-activity,  392 
Currie,  James,  301 

on  action  of  baths,  21,  22 

on  pulmonary  hemorrhage,  99 

on  treatment  of  ship-fever,  59 
of  tetanus,  89 
Curschmann,  385,  433 
Cystitis,  219 

Damage    suits    in    connection    with 

hydrotherapy,  386 
Dapper,  Carl,  on  baths,  34 

on  metabolism  and  saline  waters, 
407 
Dardel,   Dr.  Jean,  on  Aix-Ies-Bains, 
263 

on  syphilis,  201 
Dax,  391,  392 

Debility,  prescription  for,  422 
Delearde,  355 

on  bronchopneumonia,  107 
Dent,  E.  C,  291 

on  insanity,  170 
Derecq,  372 
Diabetes  insipidus,  120 

mellitus,  118 

Turkish  bath  for,  298 

prescriptions  A  and  B,  426 
Diarrhea,  iron  waters  for,  415 

morning,  156 

prescription  No.  11,  423 
Diet  and  mineral  waters,  408 

in  syphihs,  200 


INDEX 


455 


Digestion  influenced  by  water  drink- 
ing, 397 
Digestive  disorders,  150 
Dimsdale  on  typhus  fever,  59 
Diocletian,  baths  of,  372 
Diphtheria,  ice  applications,  86 
Distilled  water,  397 
Diuresis,  396 
Dosage  of  water,  444 
Douche  massage  (Aix),  263 

room,  253 

table,  164,  281 
Douches,  251 

for  tuberculous  patients,  95,  97 
Downes   on  ice-bag  for  hemoptysis, 

99 
Driburg  sulphurous  peat  baths,  335 
Drip  sheet,  246 

Drowning  in  epileptic  attack,  181 
Dryce  on  sunstroke,  91 
Duque  on  leprosy,  207 
Duval,  447 

Dysmenori'hea,  warm  bath  for,  291 
Dyspepsia,  chronic,  Turkish  bath  for, 
298 

Fleury  douche  for,  281 

nervous,  156 

EcHEVERRiA  on  epilepsy,  181 

Eclampsia,  117 

Eczema,  continuous  bath  for,  208 

iron  waters  for,  415 

Turkish  baths  unfavorable  in,  204 
Edema  of  lung,  110 
Edsall  on  chlorid  retention,  409 
Eichhorst  on  Brand  baths,  74,  75 
Ekgren,  327 
Elbrecht    apparatus    for   proctolysis, 

363 
Electric  pad,  448 
Electric-light  baths,  305 

for  nephritis,  115 
Emetic,  water  as  an,  419 
Emmet,  T.  A.,  371 
Emollient  baths  in  skin  disease,  203 
Endocarditis,  rheumatic,  126 
Enemata  of  ice-water,  76 


Enemata   of  ice-water  for  sunstroke, 
90 
of  oil  for  constipation,  153 
salt  solution,  in  pneumonia,  104 

Enteritis,  154 

Enteroptosis,  156 

Enuresis  nocturna,  166 

Epididymitis,  220 

Epilepsy,  178 
drowning  iu,  386 

Epileptics,  169 

Equipment  for  institutions,  431 

Erb,  438 

on  Brand  baths,  74 

Erysipelas,  218 

Esmarch  bandage  lowers  heat  produc- 
tion, 41 

Ethereal  solutions  absorbed  by  skin, 
22 

Eulenberg  on  epilepsy,  180 

Eureka  Springs,  Cal.,  407 

Evaporation  baths,  237 

Exercises,  Schott  treatment,  135 

Exophthalmic  goiter,  197 

Exudates  resolved,  272 

Eye  diseases,  227 

Fachingen  water,  404 
Fan  douche,  261 
Fango  packs,  332 

treatment  at  Wiesbaden,  210 
Fats  and  saline  waters,  408 
Faught's  sphygmomanometer,  50 
Felons,  214 

Fernald  on  blood-count,  56 
Ferras,  393 
Ferrous  sulphate,  416 

and  carbonate  not  absorbed  in 
baths,  23 
Ferruginous  waters,  415 
Fever,  procedures  in,  436 

remedial  nature  of,  34,  77,  106 
Filiform  douche,  262 
Finns,  sweat  baths,  301 
Fleury  douche,  280 

on  epilepsy,  178  . 
Flexner's  serum,  88 


456 


INDEX 


Flitwick,  England,  415 

Floating  baths,  New  York  City,  376 

Florida,  sea- bat  lis,  378 

Flower    Hospital,    N.   Y.,    sunstroke 
statistics,  442 

Floyer,  58,  241 

Folin,  192 

studies  in  metabolism,  36 

Fomentations,  12.5,  347,  358 

Football  accidents,  213,  215 

Foot-bath,  308 

Forchheimer  half-baths  for  diabetes 
insipidus,  120 
on  mustard  baths,  157 

Formanek  on  uric  acid  elimination, 
47 

Formic  acid,  312,  318 

Fort  Monroe,  Virginia,  316 

Foster,  169 

on  cold  packs  for  nephritis,  116 
on  epilepsy,  182 

Foulds  on  ice- water  encmata  for  sun- 
stroke, 91 

Frankenhauser  instruction  in  hydro- 
therapy, 385 

Frankl  on  oxygen  bath,  324,  331 

Franz  Josef  water,  413 

Franzcnsbad,  334,  415 

Franze  on  metabolism     in    Xauheim 
baths,  35 
on  Xaulioim  baths,  311 

French  Lick,  for  alcoholism,  150 

Fresh-  and  salt-water  baths  compared, 
20 

Frey  and   Heiligenthal,  experiments 
on  Russian  baths,  32 
on  sweating  in  baths,  1 12 

Friedrichshall  water,  203,  407 

Furunculosis,  209,  214 

Gall-stones,  404 
Gant,  241 
Gastein,  128 
Gastralgia,  396 
Gastric  acidity,  414 
ulcer,  154 

Carlsbad  water  for,  404 


Gastritis,  154 
Gastroptosis,  153 

and  water  drinking,  396 
Geigel,  course  in  hydrotherapy,  384 
Gell  on  Pompeian  baths,  373 
Geneva  Lithia  Water,  417 
Genito-urinary  diseases,  219 
German  Army,  typhoid  statistics,  436 

clinics  for  hydrotherapy,  433 
Gibney  on  sprains,  212 
Glacier  ice-water,  401 
Glaucoma,  229 
Glen  Springs,  N.  Y.,  407 

Summit  water,  399 
Gonorrheal  arthritis,  130 
Gooseflesh,  27,  41 
Gout,  127 

acute  symptoms  arising  after  baths, 
298 

affected  by  Kissingen  water,  410 

and  Uthia  waters,  419 

astlienic,  treated  at  Aix,  272 
by  douches,  281 

Nauheim  baths  in,  36 
Gouty  kidney,  sphygmographic  trac- 
ing, 52 

nephritis,  114 
Greece,  baths  of,  374 
Greenbrier    White    Sulphur   Springs, 

406 
Greyer,  417 
Groedel  on  orthodiagraph,  321 

on  salt-  and  fresh-water  baths,  30 
Grosse  on  oxygen  bath,  324 

on  treatment  of  measles,  79 
Grossmann,  isotonic  waters,  401 
Grube  on  isotonic  waters,  401 
Gynecologic  affections,  221 
and  douches,  371 

Half-bath,  243 

Hall,  407 

Halle,  course  in  hydrotherapy,  385 

Hammock  bath,  291 

Hansell  on  sweating  process  in  eye 

diseases,  228 
Hanson  on  bathing  in  scarlet  fever,  83 


INDEX 


457 


Hare  on  fever,  78 

on  ice   rubbing  in  typhoid  fever, 
72 

on  substitutes  for  Brand  baths,  65 

on  Turkish  baths,  300 
Harrodsburg,  Ky.,  413 
Harrogate,  205 

waters,  414 
Hathorn  Avater,  98 
Hawke  on  insanity,  173 
Head,  douches  to,  256 
Headache,  183 
Healing  Springs,  Virginia,  205 

water  of,  406 
Heart  diseases,  132,  428 

effect  of  drinking  water,  402 

effect  of  baths  on  its  rate,  54 

failure,  435,  436 

reduction  ia  size,  after  baths,  318, 
320 

sphygmographic  tracings,  51,  52 

weakness  in  scarlet  fever,  80 
Heat  after  operations,  214 

and  cold  to  body,  233 

degree  of  dry  heat  bearable,  25 

loss,  27 

estimated  by  Liebermeister,  40 

physical  and  chemic  regulation  of, 
26 

regulation  estimated  by  Wintemitz, 
41 

stroke,  90  ' 

Heater  for  compresses,  352,  448 
Hebra  on  continuous  bath,  216,  288 
Heidelberg,  385 
Helouan,  19 
Hematemesis,  154 
Hemiplegia,  189 
Hemoglobin,  57 
Hemoglobinuria  caused  by  cold  baths, 

45 
Hemorrhage  in  typhoid  fever,  62,  73, 
234 

pulmonary,  99 
Hemorrhoids,  hip-baths  for,  338 

prescription  for,  No.  12,  423 
Hepatic  douche,  257 


Heppolette  on  ice-water  enemata  for 

sunstroke,  91 
Hertel,  234 
Herzfeld,    Dr.    A.,    mustard    packs, 

109 
Heubner  on  mustard  bath,  309 
Hieropohs,  springs  of,  19 
Hippocrates,  434 

on  cold  baths  for  tetanus,  89 

on  cold  produces  heat,  339 

on  remedial  nature  of  fever,  34 

on  use  of  sea- water,  411 
Hirschfeld  on  arteriosclerosis,  147 
Hoffman's  orthodiagraph,  321 
Hollman  on  medicated  baths,  206 
Homburg,  406 

conditions  at,  133 

Elizabeth-bnmner,  418 

water,  410 
Homer's  description  of  Ulysses'  bath, 

58 
Hot  apphcations  in  nephritis,  115 

baths  and  metaboHsm,  45 

in  cerebrospinal  meningitis,  89 
in  tetanus,  89 

dry  pack,  344 

full  baths  for  measles,  79 

pack,  electric  pad,  448 

sponging  in  typhoid  fever,  76 

Springs,   Arkansas,   202,  204,   396, 
406 
state  regulation,  389 
Virginia,  19,  122,  129,  186,  281 

water  bathing,  291 
draughts,  395 

wet  pack,  341 
Hot-air  bath,  305 

blood  pressure  in,  54 
Huggard  on  radio-activity  of  waters, 

391 
Hinnage,  269 
Hunjadi,  413 

water,  203 

for  neuralgia,  184 
Hunner  on  cystitis,  219 
Hydremia  from  water  drinking,  401, 

403 


458 


INDEX 


Hydrogen  sulphid  absorbed  in  baths, 

23 
Hydrotherapy,  instruction  in,  383 

some  truths  about,  432 
Hyperacidity,  nervous,  414 
Hyperchlorhydria,  396 
Hyperemia,  430 
Hyperpyrexia,  435 

in  rheumatism,  124 
Hypochlorhydria,  396 
Hypochondria,  douche   to   head   for, 
257 

sea-bathing  in,  3S0 
Hysteria,  rain  douclie  for,  261 

Ice-bags,  103 

for  liemoptysis,  99 
Ice-coil,  357 
Ice-packs    dangerous    in    sunstroke, 

436 
Ice-poultice,  355 
Ice-rub,  245,  355 

in  typhoid  fever,  71 
Ice-water  dangerous  at  times,  396 
Ichthyol  baths  in  skin  tliseases,  204 
Ignatowski  on  heat  loss  in  baths,  38 
Impotence,  165 
Incantlescent  light  baths,  429 
India,  bathing  habits  in,  294 
Indians,  American,  301 
Infants,  pneumonia  of,  103 
Inflammation,  local,  210 
Influenza,  110 
Insanity,  168 

Turkish  bath  for,  298 
Insolation,  90,  436 
Insomnia,  166 

cold  tlouches  for,  254 

of  insanity,  176 
Institutions,  equipment  for,  431 
Inunctions  of  oil  in  typhoid  fever,  77 
lodin  waters,  416 
Iridocyclitis,  202 
Iritis,  227 
Iron  waters,  415 
Irrigation  for  cystitis,  220 

of  rectum,  359 


Iverson's  apparatus  for  proctolysis, 

361 
Ivy  poisoning,  218 

Jackson    on    treatment   of   typhus, 

59 
Jacobi    on    bathing    in   tuberculosis, 
94 

on  high  temperature  in  pneumonia, 
106 
Jane  way's  bed-lift,  241,  242 
Japanese  and  hot  baths,  292 
Jaundice,  Fleury  douche  for,  281 
Jet  douche,  substitute  for,  254 
Joachimstlial,  390,  392 
Jolmson  on  sprains,  212 
Jurgensen,  235 

on  reaction  to  cold  baths,  38 

Kaposi  on  continuous  bath,  290 
KeUor,  447 

Kidney-reflex,  stimulus  of,  281 
Ivinnicutt  on  Brand  baths,  69 

on  resistant  exercises,  135,  140 
Kionka  on  balneotherapy,  384 
Kisch  on  non-absorption  of  mineral 

constituents  in  baths,  22 
Kissingen,  128,  406 

mud  baths,  333 

water,  effect  of,  in  gout,  410 
Klemperer  on  solvents,  404 
Kletzinsky  on  absorption   in  baths, 

23 
Kneipp,  432 

water  cure,  254 
Kothe  on  proctoclysis,  370 
Kowalski,  234 

Koracli  on  forced  bathing,  74 
KraepeUn,  173 
Krause  on  bone  tul)erculosis,  211 

on  chorea  and  rheumatism,  87 

on  hemoptysis,  99 

on  toothache  after  baths,  231 
Kreuznach,  waters  of,  394,  416 
Kussmaul,  432 

commission  on  instruction  in  hydro- 
therapy, 437 


INDEX 


459 


Kussmaul  on  peristaltic  unrest,  157 
Kuthy  on  tuberculosis,  437 

La  bourboule,  204 
Lambert  on  sunstroke,  442 
Langenbeck  on  continuous  bath,  217, 

290 
Lansigk,  415 
Laqueur,  327 

on  uric  acid  elimination,  47 
Lead  poisoning,  149 
Leamington,  England,  407 
Leg-bath,  308 
Lehman's  experiments  on  cutaneous 

absorption,  23 
Leipsig,  course  in  hydrotherapy,  385 
Leiter  coil,  88 

illustrated,  102 
Lenhartz  on  edema  of  the  lung,  110 
Leprosy,  206 
Leuk,  205 
Levico  arsenic  spring,  415 

water  in  psoriasis,  204 
Levy-Dorn,  orthodiagraph,  321 
Lewandowiski  on  furunculosis,  209 
Liebermeister,  447 

on    lukewarm    baths    in    typhoid 
fever,  65 
Lissauer,  108 
Lithia  waters,  416 
Liver,  engorgement  of,  280 
Lockwood  on  gastroptosis,  153 
Locomotor  ataxia,  187,  188,  291 
LoSche-les-Bains,  128 
Logic  on  insanity,  170 
Londonderry  Lithia  Water,  417 
Longettenverbanden,  185 
Loofah,  296,  359 
Loomis,  436 
Lucas,  packs,  338 
Luchon,  390,  392,  414 

on  radio-activity  of  waters,  392 
Luff  on  uric  acid  fetich,  123 
Luke,  235 
Lumbago,  148,  280 

prescription  F,  427 
Lumbar  douche,  280 


Mabon,  170 

MacCullum   on   fever   as    protective 

process,  79 
Maecenas,  372 

Magnesium  sulphate  applied  in  com- 
presses, 218,  220 
solution  for  compresses,  126 
Malarial  cachexia,  iron  waters  in,  415 

disease,  Fleury  douche  for,  281 
Manhattan  State  Hospital,  291 
Mania,  douche  to  head  for,  257 

warm  baths  for,  291 
Manitou  Springs,  Colo.,  406 

water,  Colorado,  403,  415 
Marcuse  and  Strasser,  432 

on  excretion  of  urine  influenced  by 
distilled  water,  399 
Marienbad,  406,  415 

in  gynecologic  affections,  221 
Martin's  sphygmomanometer,  49 
Matthes  on  epilepsy,  180 

on  hydrotherapy,  384 

on  metabohsm  in  baths,  34 

on  tonic  reaction,  29 
Mays  on  cold  in  pnevunonia,  102 
McCrae  on  Brand  baths,  77 
McGuire  on  proctoclysis,  370 
McLean  Asylum,  studies  on  metabo- 
lism in,  36 
Measles,  79,  400 
Mechanical  irritation  in  baths,  25 

stimuU,  41 
Medical  baths  of  Boston,  142 

of  Philadelphia,  283 
Medicated  baths,  308 

in  leprosy,  206 
Melancholia,  172 

douche  to  head  for,  257 
Menstrual  disorders,  sitz-baths,  337 
Menstruation  and  Brand  baths,  71 

suppressed,  Turkish  bath  for,  298 
Mercurial  inimctions,  199 

poisoning,  149 
Mercury,  chlorid  of,  22 

cutaneous  absorption  impossible  in 
baths,  21 
Metabolism  and  hot  baths,  45 


460 


INDEX 


Metabolism  and  saline  waters,  407 
and  water  drinking,  395 
effect  of  baths  on,  33 

influenced  by  cold  baths,  34 
meaning  of,  127 
Metallic  poisoning,  187 
Metritis,  222 

Mineral    constituents    of    baths    not 
absorbed  by  the  unbroken  skin, 
22,  23,  24 
waters,  3SS 

classification,  390 

radio-active,  394 

Misiewitz  on  hip-baths,  338 

MitcheU,  S.  Weir,  163,  181 

on  heat  and  cold  to  spine,  354 
on  sciatica,  186 
Montefiore  Home,  447 
Moor  baths  for  arthritis,  131 
Moritz's  orthodiagraph,  321 
Morphinism,  149 
Morton    on    artificially    radio-active 

waters,  394 
Mosler  on  contraction  of  spleen,  161 
Mosso,  49 
Mouren  and  Lepape  on  estimate  of 

radio-activity,  392 
Mt.  Clemens,  Mich.,  407,  409 
analysis,  19 
for  sj-philis,  198 
sulpliur  baths  for  gout,  129 
Mud  batlis,  332 

for  arthritis,  131 
Murphy's  method  of  proctolysis,  148, 

158,  361 
Musser  on  Brand  baths  ip  tj'phoid 
fever,  63 
on  chlorid  retention,  409 
on  use  of  alcoliol  in  Brand  baths,  61 
Mustard  bath,  309 
foot-bath,  105,  106 
packs  in  bronchitis,  108 
Miitterlauge,  312 
Myalgia,  arc-light  bath  for,  427 
Myelitis,  291 
Myocarditis,  148 
Myositis,  148 


Napa  Soda  Springs,  Cal.,  406,  415 
Xaturarzt,  432,  433 
Nauheim  bath,  20,  310 

baths  and  arterial  tension,  48 
and  Schott  exercises,  134 
artificial  173,  428 
for  anemia,  159 
for  gout  36,  129 
for  nephritis,  114 
in  gjTiecologic  affections,  221 
in  rheumatism,  36 
metaboUsm  in,  36 
prescription  H,  427 
visitors  to,  133 
Needle  douche,  251 
Nenndorf,  Prussia,  414 
Nephritis,  113,  114 

after  acute,  sea  baths  dangerous, 

382 
aggravated  by  saline  waters,  409 
chronic,  281 

interstitial,  prescription  D,  426, 

428 
parenchymatous,       prescriptions 
for,  Nos.  7,  21,  422 
of  scarlet  fever,  118 
use  of  water  internally,  396 
water  drinking,  400 
Neptune's  girdle,  151,  167,  179,  356 
Ner\'ous  dj^spepsia,  156 
prescription  for,  422 
sea-bathing,  380 
Neuralgia,  184 
and  neuritis,  430 
prescription  for.  No.  9,  423 
rain  douche  for,  261 
Neurasthenia,  162 
in  tuberculosis,  99 
prescriptions  for,  Nos.  1,  2,  3,  15, 

16,  422 
rain  douche  in,  261 
sea-bathing,  380 
sexual,  165 
Neuritis,  186 

and  neuralgia  treated  at  Aix,  272 
arc  light,  427 
Neuroses  of  bladder,  166 


INDEX 


461 


Neurovascular  training,  163 
Neusser  on    radio-active    treatment, 

393 
New  York  City  public  baths,  376 

Hydrotherapeutic  Apparatus  Co., 
284 
Nitrogen  elimination  in  baths,  32 
Nitroglycerin  an  aid  in  hydrotherapy, 

92 
Noeggerath,  289  ^^ 

Noorden,  von,  30 

on  cold  appUcations  in  nephritis, 

116 
on  Fachingen  water,  404 
on  metabolism  and  sahne  waters, 
407 
in  baths,  34 
on  sulphur  water  in  hyperacidity, 

414 
on  sweating  in  renal  disease,  1 12 
on  water  restriction  in  nephritis,  401 
Nutrition,  defective,  prescription  for, 
446 

Oak  Orchard  Springs,  N.  Y.,  415 
Obesity,  190,  224,  428 

prescription  for,  446 

sea-bathing  in,  380 

Turkish  bath  in,  298 

use  of  water  in,  400 
O'Dwyer  on  sunstroke,  442 
Oertel  on  obesity,  400 

system,  318 
Oil  enemata,  153 

immctions  in  scarlet  fever,  86 
in  typhoid  fever,  77 

rub,  249 
Old  age  and  sea-bathing,  381 
Ophthalmia  neonatorum,  227 
Oppenheimer  on  packs  and  baths  in 

scarlet  fever,  85 
OrcMtis,  220 

Orthodiagraph,  142,  146,  321 
Osier,  48,  436 
Osmotic  pressure,  213 
Osteomyehtis,  211 
Overexertion,  53 


Oxygen  bath,  148,  323 
in  insanity,  173 
intake  in  hot  baths,  46 
Ozet  bath,  oxygen  bath,  324 

Pacitic  Congress  Springs,  Cal.,  415 
Pack,  coohng  wet  sheet,  237 

table,  35 
Packs,  338 

cool,  in  scarlet  fever,  81 

Fango,  332 

mustard,  in  bronchitis,  108 
Pail  douche-  or  pail-pour,  278 
Palm    Beach,    temperature    of    sea- 
water,  378 
Paradoxes,  339,  407 
Paralysis,  187 
Paraplegia,  187,  291 
Parasite  skin  diseases,  208 
Parmelee  still  and  sterihzer,  398 
Passavant  on  continuous  bath,  216 
Paulus  of  iEgina,  289,  442 
Peabody,  436 

Peck  on  electric-Hght  baths,  307 
Pemphigus,  209 

continuous  bath  for,  288,  290 
Pennsylvania  Epileptic  Hospital,  182 
Percussion  douche,  278 
Perineal  douche,  258,  262 
Peripheral  neuritis,  187 
Peristaltic  unrest,  157 
Peritonitis,  158 

continuous  bath  for,  289 
Peters  on  douche  in  tuberculosis,  97 
Pfaefers-Ragatz,  128 
Pharyngitis,  Turkish  bath  for,  298 
Philadelphia  Hospital  for  the  Insane, 
169,  173 

houses  with  bath-tubs,  377 

medical  baths,  283 

pool  baths,  376 
Phlebitis  treated  at  Aix-les-Bains,  272 
Phlegmons,  214 
Phosphaturia,  120 
Physical  regulation  of  heat,  26 
Pick  on  epilepsy,  179 
Pierce  on  action  of  waters  of  Bath,  20 


402 


INDEX 


Pine-needle  bath,  309,  314 

Pine  Ridge,  R.  I.,  Sanatorium,  97 

Piscines  at  Aix,  270 

Pistyan  Springs,  Austria,  radio-active, 

395 
Plombieres,  128,  391 

douche,  183,  270,  370 

in  gynecologic  affections,  221 
Plunge  bath,  238 
Pluto  Spring  AVater,  P>ench  Lick,  150, 

184 
Pneumonia,  100 

ice  in,  235 
Poland  Springs,  Maine,  399 
Pompeii,  baths  of,  372 
Pope,  235 

on  compresses,  350 
Pospischil,  185 

on  rate  of  heat  production,  37 
Potain,  49 
Potassium  chlorid  baths,  30 

ferrocyanid  not  absorbed  in  baths, 
23 

nitrate  not  absorbed  in  baths,  23 
Pozzi  on  vaginal  douches,  371 
Pratt,  385 

on  cardiac  insufficiency,  141 

on  choice  of  procedures,  44 

on  hot-air  baths,  47 

on  prescriptions,  421 
Precautions,  sea  baths,  381 
Prescriptions  for  hydrotherapy,  420 
Priessnitz,  59 

cross-binder  for  cough,  98 

half-bath,  243 

pack,  108,  339 
Proctolysis,  361 
Prolapsus  ani,  338 
Prostatic    hypertrophy,    prescription 

for,  No.  12,  423 
Psoriasis,  204 

Royat  water,  416 
Piillna  water,  413 
pulmonary  congestion,  109 
Pulse  in  typhoid,  60 
Purgative  waters,  413 
Purton  Spa,  416 


Putnam,  421 
Pyosalpinx,  223 
Pyrmont  water,  399,  415 
bottled,  416 

Rabateau  on  cutaneous  absorption  in 

baths,  23 
Radio-active  waters  internally,  412 
Radio-activity  of  waters,  390 
Rain  bath  lowers  heat  production  if 
warm,  41 

douche,  258,  259,  278 
Rakoczy  Spring,  418 
Ransom  on  sweating  and  albuminuria, 

113 
Rationale  of  hydrotherapy,  17 
Reaction,  26 

after  cold,  435 

after  sea-bathing,  380 

painful  after  baths,  122 
Rectal  irrigation,  359 
Reduction  cure,  191 
Reflex  action  of  thermic  stimuli,  25 
Reiche,  furunculosis,  209 
Renal  calculus,  Fleury  douche  for,  281 

comphcations  and  Brand  baths,  71 

diseases.  111 
Respiration  affected  by  baths,  31 
Respiratory  changes,  57 
Rheumatic  myositis,  148 
Rheumatism,  120 

and  gout,  225 

chronic,  treated   at  Aix-les-Bains, 
272 

Nauheim  baths  in,  36 

or  gout,  prescription  for,  446 

prescription  for.  No.  9,  423 

treated  at  various  springs,  20 
Richelot  on  vaginal  douches,  371 
Richfield  Springs,  N.  Y.,  205,  409 

for  gout,  129 
Rieder,  30 

Riesman  on  crounotherapy,  388 
Riess  on  continuous  bath,  290 

on  warm  full  bath  in  typhoid  fever, 
71 
Riley,  49 


INDEX 


46^ 


Ringer's  solution,  104 

Risley  on  sweating  process  in  eye  dis- 
eases, 229 

Ritter   on   cutaneous   absorption   in 
baths,  23 

Riva-Rocci's  sphygmomanometer,  49 

Rives,  135 

Robin    on    nitrogen    elimination    in 
baths,  32 

Rochester  on  chlorid  retention,  409 
on  treatment  of  pneumonia,  105 

Rock  Enon  Spring,  Va.,  415 

Rockbridge  Almn  Spring,  Va.,  415 

Rogansky  on  cerebrospinal  meningi- 
tis, 88 

Rohrig's  experiments  on  absorption 
in  baths,  23 

Roller  bandage  applied  wet,  218 

Roman  bath,  304 

Romberg  on  Brand  baths,  74 

Roncegno  Arsenic  Spring,  415 
water  in  psoriasis,  204 

Rontgenography,  322 

Rose  on  continuous  bath,  216 

on  history  of  continuous  bath,  289 

Royat,  204,  415,  416 

Rubbing  in  Brand  baths,  65 

Rubinat  water,  413 
for  neuralgia,  184 

Rubner  on  metabolism,  40 
and  water  drinking,  395 
on  respiratory  changes  in  cold  baths, 
39 

Rubs,  249 

Rudolf  and  Beck,  322 

Russian  bath,  301 

effect  on  urine  and  bodily  tem- 
perature, 33 

Rutherford  on  radio-activity,  394 

Sadger  on  hemorrhage  from  gastric 
ulcer,  154 

Sadler  on  instruction  in  hydrotherapy, 
384 
on  treatment  of  obesity,  195 

SaHcylic  acid   not   absorbed   by   un- 
broken skin  in  baths,  22  | 


Saline  baths  and  fresh  water  baths 
compared,  30 

waters,  406 

and  metabolism,  407 
Salpingitis,  224 
Salt  rub,  94,  354 

for  nephritis,  116 

in  neurasthenia,  162 
Sand-baths,  335 
Sandow's  bath,  315 
Sandwich  Springs,  Canada,  407 
Sarason,  oxygen  bath,  323 
Saratoga,  407 

Springs,  417 

vichy,  403 

waters,  184,  203 
Satterthwaite,  312,  316 

on  resistant  exercises,  135 
Saxon  on  apparatus  for  proctolysis, 

366 
Scarlatinal  nephritis,  118 
Scarlet  fever,  80 

Schnuetgen  on  oxygen  bath,  327 
Schondorff   on    water   drinking   and 

uric  acid,  395 
Schott,  318 

resistant  exercises,  135,  311 
Schultze  on  Brand  baths,  74 

on  temperature  of  body  after  heat 
and  cold,  233 
Schwalbach,  415,  416 
Schweinburg,  179,  234,  235 
Sciatica,  184,  291 

prescription  F,  427 
Scleroses,  187,  188 
Scotch  douche,  125,  256 
for  sciatica,  185 

rub,  250 
Scrofula,  iron  waters  in,  415 
Sea-baths,  27,  168,  186,  189,  260,  377 

as  preventive  measure,  94 
increase  urea,  113 
Seasickness,  158 
Sea-water  for  Nauheim  baths,  316 

injections,  411 
Sedative  treatment,  430 
See,  Germain,  on  obesity,  400 


464 


IXDEX 


Seguin    on    cutaneous  absorption  in 

mineral  baths,  21 
Semmola,  438 
Senator  on  sweating  in  renal  disease, 

111 
Shampoo,  297 

Swedish,  359 
Sharon  Springs,  N.  Y.,  for  gout,  129 
Sharpe  on  Fango  packs,  333 
Sheet  bath,  246 

in  typhoid  fever,  76 
Shepherd's  sprinkler,  245 
Sheppard  and  Enoch  Pratt  Hospital, 

168 
Shivering,  27,  39,  381 

in  Brand  baths,  68 
Shober  on  radio-activity,  394 
Shock,  214 
Shower  baths,  375 

heat  elimination  in,  37 
Silva,  234 
Sinapisms,  107 
Sitz-baths,  226,  336 

for  constipation,  153 
for  nervous  dyspepsia,  156 
Skin,  cutaneous  absorption  in  mineral 
baths,  21 

diseases,  203 

permeable    to    gases    and    volatile 
constituents  of  baths,  23 

vicarious  action  of,  47 
Sleeplessness,  147 
Smedley's  England,  334 
Smith,  Nathan,  59 
Soden,  128,  407 
Sodic  bromo-iodin  waters,  416 
Sodium  chlorid  retention,  409 
Sommer  on  oxygen  bath,  325 
Spa,  Belgium,  415 
Spas,  clioicc  of,  for  gout,  128 

drinking  cuces  at,  114 
Spermatorrhea,  165 
Sphygmographic  tracings,  49 
Sphygmomanometer,  49 
Spinal  douche,  255 
Splenic  enlargement,  161 
Sponging,  73,  76,  248 


Sponging  in  typhoid,  62,  73 
Sprains,  211 
Spray  bath,  244 
Sprinkler,  245 
Sprinkhng,  73,  75 
Sprudel  baths,  311 
St.  Anne's  Well,  England,  415 
Stanton's  sphygmomanometer,  50 
St.  Catherine's  Wells,  Canada,  407 
Steam  douche,  108,  262 
Stengel  on  Brand  baths    in  typhoid 
fever,  63 

on  use  of  alcohol  in  Brand  baths,  61 
SteriUty  in  women,  222 
Stimulants,  alcoholic,  28 
Stimulating  effect  of  baths,  24 

treatments,  429 
St.  Moritz,  Switzerland,  415 
Stockton  on  cerebrospinal  meningitis, 
87 

on  insanity,  176 
Stomatitis,  199 
Strasser,  235 

Strathpeffer  waters,  Scotland,  414 
Stromeyer,  continuous  bath,  290 
Striimpell,  von,  on  Brand  baths,  74, 75 
St.  Vincent  Hospital,  N.  Y.,  sunstroke 

statistics,  442 
Sugar  excretion  influenced  by  sweat- 
ing, 47 
Sulphur  waters,  413 
for  gout,  128 
in  nephritis,  114 
in  psoriasis,  205 
in  syphilis,  201 
Sunstroke,  90,  436,  442 
Surf-bathing.     See  Sea-baths. 
Surgical  affections,  209 
Sweating,  111 

in  steam  baths,  113 

processes  for  eye  diseases,  227 
Sweedish  shampoo,  359 
Swimming  accidents,  381 
Synovitis  of  knee,  215 
Syphilis,  197 

treated  at  Aix-les-Bains,  272,  273 

Turkish  bath  for,  298 


INDEX 


465 


Tar  ASP,  221 

Technic  of  hydrotherapy,  232 
Teilwaschung,  246 

Temperature    of    body    affected    by 
baths,  31 

reduction,  435 

standards,  233 
Tepid  baths,    metabolism   not    influ- 
enced by,  48 
Teplitz,  128 
Tetanus,  89 
Thermal  waters,  396 
Thermic  fever,  90 

stimulation,  effect  on  heart  rate,  55 
Thermometer,  233 
Thermometric  scales  compared,  420 
Thermophore,  448 
Thermopylae,  19 
Thompson,  436 

on  experiments  on  heat  and  cold  to 
body,  234 

on  rules  for  use  of  Brand  baths,  65, 
68 

on  use  of  alcohol  in  Brand  baths,  61 
Thomson  on  cutaneous  absorption  in 

baths,  23 
Thome,  Bezley,  144 

LesUe,  144,.  323 
Tinea,  208 
Tobacco  habit,  149 
Tonic,  general,  prescription  Nos.  13, 

14,  423 
Toothache  after  baths,  231 
Tornai  on  oxygen  bath,  324,  326 
Toxemia  in  typhoid  fever,  435 

of  pneumonia,  106 

of  pregnancy,  117 
Toxemic  myocarditis,  148 
Toxins  and  blood-pressure,  53 

excretion  of,  77 

in  nephritis,  115 
Triton  salts  for  Nauheim  baths,  225, 

313 
Tub  for  Brand  baths,  61,  64,  66 
Tuberculosis,  93 

Baruch,  437 

surgical,  211 
30 


Tubingen,  386 

Tucker   on    use   of    magnesium  sul- 
phate solution,  220 
Tunbridge  Wells,  England,  415 
Turkish  bath,  295 

abuse  of,  134 

coimterindications,  120,  299 

effect  on  respiration,  32 

eHmination  of  urea  and  uric  acid 
in,  32 

for  anemia,  160 

gain  of  weight  in,  36 

in  sypliihs,  203 

not  for  asthma,  243 

temperature  effect  of,  32 
Tuttle  on  studies  in  metaboKsm,  36 

on  mental  effects  of  baths,  43 
Tycos  sphygmomanometer,  51 
Tympany,  rectal  irrigation  in,  361 
Typhoid  fever,  59 

Baruch,  435 

colonic  irrigation  in,  361 

continuous  bath,  290 

water  drinking  in,  396,  402 
Tyson,  312 

on  Brand  baths,  45,  61 
on  chlorid  retention,  409 

Ukaiah  Vichy,  CaL,  403 

Ulysses  bath,  described  by  Homer,  58 

Umber,  Brand  baths,  75 

Uremia,  117 

Uriage,  221 

Uric  acid,  123 

and  Fachingen  water,  404 

and  litliia  waters,  418 

and  saUne  waters,  410 

excretion,  47 

not  influenced  by  water  drinking, 
395 
Urine,  effect  of  Brand  baths,  Tyson,  45 
effected  by  cold  packs,  117 

Vaginal  douche,  370 
Vals,  403 
Vapor  bath,  301 

for  syphiHs,  202 


466 


INDEX 


Vasomotor  spasm,  Ifil 

Vaughan  on  chlorid  retention,  409 

Vichy  ("elostin,  403 

douche,  276 

water  in  scarlatinal  nephritis,  118 
Victoria  water,  Austria,  413 
Virginia  Beach,  sea-bathing,  378 

Hot  Springs,  122,  129,  18(3,  281 
analysis,  19 
Visceral  anemia,  161 
Volksbad,  Vienna,  376 
von  Basch,  49 
von  Xoorden,  30 

von  Striimpell  on  Brand  baths,  74,  75 
von  Walther,  289 

AVarm  full  bath  in  typlioid  fever,  71 

Springs,  Virginia,  205 
Warmbrunn,  128 
Water  as  emetic,  419 

used  internally,  395 
"Waukesha,  AVisconsin,  407 
AVeber  on  reaction,  27 
AA'eilbach  Sulphur  Spring,  414 
AA'eintraub  on  Brand  baths,  74 
Wells  on  chlorid  retention,  409 
Wet  pack,  440 

mit  friction,  246 
Wherry  on  epilepsy,  182 
AA'hite  on  bidet,  165 

Rock  water,  417 

Sulphur  Springs,  205 
Widal  and  Javal  on  chlorid  retention, 

409 
Wiesbaden,  209 
Wildbad,  221 

for  gout,  128 
Wildungen,  406 
AA'ilhelmsquelle,  Ems,  418 
AA'ill  power  increased  by  cold,  41 
AVilliams,  388 

on  hot  wet  pack,  343 

on  saline  waters  and  gout,  410 
Wilson,  235,  436 


AA^ilson  on  hot  baths  in  typhoid  fever, 
35 

on  use  of  alcohol  in  Brand  baths,  61 
AA'inckler  on   use   of   distilled   water 

safe,  399 
AVintemitz,  432,  433 

on  epilepsy,  178 

on    experiments   on  absorption   in 
baths,  22 
on  heat  regulation,  41 

on  gastric  ulcer,  155 

on  hot  baths  and  oxygen  intake,  46 

on  measles,  79 

on  oxygen  bath,  327 

on  reaction,  27,  29 

on  roller  bandage  apphed  wet,  218 

on  sweating,  112 

on  typhoid  fever,  60 
Wolbarst  on  rectal  irrigator,  359 
AA'olcott  on  radio-active  waters  of  Col- 
orado, 391 
AA'ohsch  on  cerebrospinal  meningitis, 

88 
AA'ood  on  attacks  of  gout,  127 

on  splenic  enlargement,  161 

on  surgical  shock,  214 

on  thermic  stimuli,  25 
AVoodhall,  416 

Wright  on  treatment  of  tetanus  in  the 
AA'est  Indies,  89 

Rebekah  B.,  235 
AA'urzburg  course   in   baUieotlierapy, 

384 

Yellow  fever,  89 

Yellowstone  National  Park,  18,  388 

Zander  method  and  apparatus,  274, 

210 
Zeozon,  oxygen  batli,  323 
Zickel,  326 

Ziemssen's  cold  baths,  447 
Zucker's  carbonated  baths,  226,  313 
Zuschlag  on  continuous  bath,  288 


SAUNDERS'     BOOKS    ON 


Barnhill  and  Wales* 
Modern   Otology 

A  Text-Book  of  Modern  Otology.  By  John  F.  Barnhill,  M.  D., 
Professor  of  Otology,  Laryngology,  and  Rhinology,  and  Earnest 
DE  W.  Wales,  M.  D.,  Associate  Professor  of  Otology,  Laiyngology, 
and  Rhinology,  Indiana  University  School  of  Medicine,  Indianapolis. 
Octavo  of  575  pages,  with  305  original  illustrations.  Cloth,  $5.50  net; 
Half  Morocco,  $7.00  net. 

THE    PRACTITIONER'S    OTOLOGY 

The  authors,  in  writing  this  work,  kept  ever  in  mind  the  needs  of  the 
physician  engaged  in  general  practice.  It  represents  the  results  of  personal 
experience  as  practitioners  and  teachers,  influenced  by  the  instruction  given  by 
such  authorities  as  Sheppard,  Dundas  Grant,  Percy  Jakins,  Jansen,  and  Alt. 
Much  space  is  devoted  to  prophylaxis,  diagnosis,  and  treatment,  both  medical 
and  surgical.  There  is  a  special  chapter  on  the  bacteriology  of  ear  affections — 
a  feature  not  to  be  found  in  any  other  work  on  -otology.  Great  pains  have  been 
taken  with  the  illustrations,  in  order  to  have  them  as  practical  and  as  helpful  as 
possible,  and  at  the  same  time  highly  artistic.  A  large  number  represent  the 
best  work  of  Mr.  H.  F,  Aitken. 


PERSONAL    AND    PRESS    OPINIONS 


Frank  Allport,  M.  D. 

Professor  of  Otology,  Northwestern  University,  Chicago. 

"  I  regard  it  as  one  of  the  best  books  in  the  English  language  on  this  subject.  The 
pictures  are  especially  good,  particularly  as  they  are  practically  all  original  and  not  the  old 
reproduced  pictures  so  frequently  seen." 

C.  C.  Stephenson.  M.  D. 

Professor  of  Ophthalmology  aud  Otology,  College  of  Physicians  and  Surgeons,  Little  Rock, 
Arkansas. 

"  To  my  mind  there  is  no  work  on  modem  otology  that  can  for  a  moment  compare  with 
'  Barnhill  and  Wales.'  " 

Journal  American  Medical  Association 

"Its  teaching  is  sound  throughout  and  up  to  date.  The  strongest  chapters  are  those  on 
suppuration  of  the  middle  aar  and  the  mastoid  cells,  and  the  intracranial  complications  of  ear 
disMise." 


DISEASES   OF   THE  EYE, 


DeSchweinitz's 
Diseases  of  the  Eye 

The   New    (5th)    Edition 

Diseases  of  the  Eye :  A  Handbook  of  Ophthalmic  Practice, 
By  G.  E.  DeSchweinitz,  M.D.,  Professor  of  Ophthalmology  in  the  Uni- 
versity of  Pennsylvania,  Philadelphia,  etc.  Handsome  octavo  of  894 
pages,  313  text-illustrations,  and  6  chromo-lithographic  plates.  Cloth, 
^5.00  net;  Sheep  or  Half  Morocco,  ,^6.50  net. 

WITH  313  TEXT-ILLUSTRATIONS  AND  6  COLORED  PLATES 

For  this  new  edition  the  text  has  been  very  thoroughly  revised,  and  the  work 
enlarged  by  the  addition  of  new  matter  to  the  extent  of  some  one  hundred  pages. 
There  have  been  added,  amongst  other  subjects,  chapters  on  the  following  :  X-Ray 
Treatment  of  Epithelioma,  Xeroderma  Pigmentosum  ;  Purulent  Conjunctivitis  of 
Young  Girls  ;  Jequiritol  and  Jequiritol  Serum  ;   X-ray  Treatment  of  Trachoma 
Infected  Marginal  Ulcer  ;  Keratitis  Punctata  Syphilitica  ;  Uveitis  and  Its  Varieties 
Eye-  ground  Lesions  of   Hereditary  Syphilis  ;    Macular  Atrophy  of  the  Retina 
Worth's  Amblyoscope  ;   Stovain,  Alypin  ;   Motais'    Operation  for  Ptosis  ;   Kuhnt- 
Miiller's  Operation  for  Ectropion  ;    Haab's    Method   for    Foreign    Bodies  ;    and 
Sweet's  X-Ray  Method  of  Localizing  Foreign  Bodies.     Other  chapters  have  been 
rewritten.     The  excellence  of  the  illustrative  feature  has  been  maintained. 


PERSONAL  AND   PRESS  OPINIONS 


Samuel  Theobald,  M.D., 

Clinical  Professor  of  Ophthalmology ,  Johns  Hopkins  University,  Baltimore. 
"  It  is  a  work  that  I  have  held  in  high  esteem,  and  is  one  of  the  two  or  three  books  upon 
the  eye  which  I  have  been  in  the  habit  of  recommending  to  my  students  in  the  Johns  Hopkins 
Medical  School." 

W.  Franklin  Coleman,  M.  D., 

Professor  of  Diseases  of  the  Eye,  Postgraduate  Medical  School,  Chicago. 

"I  am  very  much  pleased  with  deSchweinitz's  work  and  will  recommend  it  to  the  members 
of  my  class  as  a  most  reliable,  complete,  and  up  to  date  text-book." 

British  Medical  Journal 

"A  clearly  written,  comprehensive  manual.  One  which  we  can  commend  to  students  iaH  a 
reliable  text-book,  written  with  an  evident  knowledge  of  the  wants  of  those  entering  upon  the 
Stady  of  this  special  branch  of  medical  science." 


SAUNDERS'    BOOKS    ON 


Brtihl,  Politzer,  and  Smith's 
Otology 


Atlas  and  Epitome  of  Otology.  By  Gustav  Bruhl,  M.  D.,  of 
Berlin,  with  the  collaboration  of  Professor  Dr.  A.  Politzer,  of 
Vienna.  PMited,  with  additions,  by  S.  MacCuen  Smith,  M.D.,  Pro- 
fessor of  Otology  in  the  Jefferson  Medical  College,  Philadelphia. 
With  244  colored  figures  on  39  lithographic  plates,  99  text  illustra- 
tions, and  292  pages  of  text.  Cloth,  ;$3.oo  net.  /;/  Saumiirs'  Hand- 
Atlas  Series. 

INCLUDING  ANATOMY  AND  PHYSIOLOGY 

The  work  is  both  didactic  and  clinical  in  its  teaching.  A  special  feature  is 
the  very  complete  exposition  of  the  minute  anatomy  of  the  ear,  a  working  knowl- 
edge of  which  is  so  essential  to  an  intelligent  conception  of  the  science  of  otology. 
The  association  of  Professor  Politzer  and  the  use  of  so  many  valuable  specimens 
from  his  notably  rich  collection  especially  enhance  the  value  of  the  treatise.  The 
work  contains  everything  of  importance  in  the  elementary  study  of  otology. 

Clarence  J.  Blake,  M.  D.. 

Professor  of  Otology  in  Harvard  University  Medical  School,  Boston. 

"  The  most  complete  work  of  its  kind  as  yet  published,  and  one  commending  itself  to  both 
the  student  and  the  teacher  in  the  character  and  scope  of  its  illustrations.  " 

Haab  and  deSchweinitz*s 
Operative  Ophthalmology 

Atlas  and   Epitome  of    Operative    Ophthalmology.       B}-  Dr.  O. 

Haab,  of  Zurich.  Pxlited,  with  additions,  by  G.  E.  deSchweinitz, 
M.  D.,  Professor  of  Ophthalmology  in  the  University  of  Pennsylvania. 
With  30  colored  lithographic  plates,  154  text-cuts,  and  375  pages  of 
text.     /«  Saunders'  Hand-Atlas  Series.     Cloth,  $3.50  net. 


Dr.  Haab's  Atlas  of  Operative  Ophthalmology  will  be  found  as  beautiful  and 
as  practical  as  his  two  former  atlases.  The  work  represents  the  author' s  thirty 
years'  experience  in  eye  work.  The  various  operative  interventions  are  described 
with  all  the  precision  and  clearness  that  such  an  experience  brings.  Recognizing 
the  ftict  that  mere  verbal  descriptions  are  frequently  insufficient  to  give  a  clear 
idea  of  operative  procedures.  Dr.  Haab  has  taken  particular  care  to  illustrate 
plainly  the  different  parts  of  the  operations. 

Johns  Hopluns  Hospital  Bulletin 

"  The  descriptions  of  the  various  operations  are  so  clear  and  full  that  the  volume  can  well 
hold  place  with  more  pretentious  text-books." 


DISEASES   OF  THE  EYE. 


Haab  and  DeSchweinitz*s 
External  Diseases  qf  the  Eye 


Atlas  and  Epitome  of  External  Diseases  of  the  Eye.     By  Dr.  O. 

Haab,  of  Zurich.  Edited,  with  additions,  by  G.  E.  deSchweinitz, 
M.  D.,  Professor  of  Ophthalmology,  University  of  Pennsylvania.  With 
1 01  colored  illustrations  on  46  lithographic  plates  and  244  pages  of 
text.     Cloth,  $3.00  net.     In  Saunders'  Hand-Atlas  Series. 

THE   NEW    (3d)    EDITION 

Conditions  attending  diseases  of  the  external  eye,  which  are  often  socompHcated, 
have  probably  never  been  more  clearly  and  comprehensively  expounded  than  in 
the  forelying  work,  in  which  the  pictorial  most  happily  supplements  the  verbal 
description.     The  price  of  the  book  is  remarkably  low. 

The  Medical  Record,  New  York 

"  The  work  is  excellently  suited  to  the  student  of  ophthalmology  and  to  the  practising 
physician.     It  cannot  fail  to  attain  a  well-deserved  popularity." 

Haab  and  DeSchweinitz V 
Ophthalmoscopy 

Atlas  and  Epitome  of  Ophthalmoscopy  and  Ophthalmoscopic 
Diagnosis.  By  Dr.  O.  Haab,  of  Zurich.  Edited,  with  additions,  by 
G.  E.  deSchweinitz,  M.  D.,  Professor  of  Ophthalmology,  University 
of  Pennsylvania.  With  152  colored  lithographic  illustrations  and  92 
pages  of  text.     Cloth,  ^3.00  net.     /;/  Saunders''  Hand- Atlas  Series. 

THE  NEW   (2d)    EDITION 

.The  great  value  of  Prof.  Haab's  Atlas  of  Ophthalmoscopy  and  Ophthalmo- 
scopic Diagnosis  has  been  fully  established  and  entirely  justified  an  English 
translation.  Not  only  is  the  student  made  acquainted  with  carefully  prepared 
ophthalmoscopic  drawings  done  into  well-executed  lithographs  of  the  most  im- 
portant fundus  changes,  but,  in  many  instances,  plates  of  the  microscopic  lesions 
are  added.  The  whole  furnishes  a  manual  of  the  greatest  possible  service. 
The  Lancet,  London 

"We  recommend  it  as  a  work  that  should  be  in  the  ophthalmic  wards  or  in  the  library  of 
every  hospital  into  which  ophthalmic  cases  are  received." 


SArxDKRS'  nooK's  ox 


Cradle's 
Nose,  Pharynx,  and  Ear 

Diseases  of  the  Nose,  Pharynx,  and  Ear.  By  Henry  Gradle, 
M.  D.,  Professor  of  Ophthalmolot^\-  and  Otology,  Northwestern  Uni- 
versity Medical  School,  Chicago.  Handsome  octavo  of  547  pages, 
illustrated,  including  two  full-page  plates  in  colors.     Cloth,  ;iS3.50  net. 

INCLUDING  TOPOGRAPHIC  ANATOMY 

This  volume  presents  diseases  of  the  Nose,  Pharynx,  and  Ear  as  the  author 
has  seen  them  during  an  experience  of  nearly  twenty-five  years.  In  it  are 
answered  in  detail  those  questions  regarding  the  course  and  outcome  of  diseases 
which  cause  the  less  experienced  observer  the  most  anxiety  in  an  mdividual  case. 
Topographic  anatomy  has  been  accorded  liberal  space. 

Pennsylvzoiia  Medical  Journal 

'This  is  the  most  practical  volume  on  the  nose,  pharynx,  and  ear  that  has  appeared 
recently.  ...  It  is  exactly  what  the  less  experienced  observer  needs,  as  it  avoids  the  confusion 
incident  to  a  categorical  statement  of  everybody's  opinion." 

Kyle's 
Diseases  of  Nose  and  Throat 


Diseases  of  the  No^e  and  Throat.  By  D.  Braden  Kyle,  M.  D., 
Professor  of  Laryngology  in  the  Jefferson  Medical  College,  Phila- 
delphia. Octavo,  797  pages;  with  219  illustrations,  26  in  colors. 
Cloth,  $4.00  net;  Half  Morocco,  |!5.50  net. 

THE    NEW    (4th)    EDITION 

Four  large  editions  of  this  excellent  work  fully  testify  to  its  practical  value. 
In  this  edition  the  author  has  revised  the  text  thoroughly,  bringing  it  absolutely 
down  to  date.  With  the  practical  purpose  of  the  book  in  mind,  extended  con- 
sideration has  been  given  to  treatment,  each  disease  being  considered  in  full,  and 
definite  courses  being  laid  down  to  meet  special  conditions  and  symptoms. 
Pennsylvemia  Medical  Journal 

"  Dr.  Kyle's  crisp,  terse  diction  has  enabled  the  inclusion  of  all  needful  nose  and  throat 
knowledge  in  this  book.  The  practical  man,  be  he  special  or  general,  will  not  search  in  vain 
for  anything  he  needs." 


EYE,    EAR,    NOSE,    AND    THROAT. 


GET  i^  •  THE  NEW 

THE    BEST  t\  ill  6  A    1  C  Si  11  STANDARD 

Illustrated   Dictionary 

Just    Ready— The    New    (5th)    Edition 


The  American  Illustrated  Medical  Dictionary.  A  new  and  com- 
plete dictionary  of  the  terms  used  in  Medicine,  Surgery,  Dentistry, 
Pharmacy,  Chemistry,  and  kindred  branches  ;  with  over  lOO  new  and 
elaborate  tables  and  many  handsome  illustrations.  By  W.  A.  Newman 
Borland,  M.  D.,  Editor  of  "  The  American  Pocket  Medical  Diction- 
ary." Large  octavo,  nearly  876  pages,  bound  in  full  flexible  leather. 
Price,  ^4.50  net;  with  thumb  index,  ^5.00  net. 

A   KEY  TO  MEDICAL  LITERATURE— WITH  2000  NEW  TERMS 

In  this  edition  the  book  has  been  subjected  to  a  thorough  revision.  The 
author  has  also  added  upward  of  two  thousand  important  new  terms  that  have 
appeared  in  medical  literature  during  the  past  few  months. 

Howard  A.  Kelly,  M.  D., 

Professor  of  Gynecologic  Surgery,  Johns  Hopkins  University,  Baltimore 

"Dr.  Dorland's  Dictionary  is  admirable.  It  is  so  well  gotten  up  and  of  such  convenient 
size.     No  errors  have  been  found  in  my  use  of  it." 

Theobald's  Prevalent  Eye  Diseases 


Prevalent  Diseases  of  the  Eye.  By  Samuel  Theobald,  M.  D., 
Clinical  Professor  of  Ophthalmology  and  Otology,  Johns  Hopkins 
University.  Octavo  of  550pages,  with  219  text-cuts  and  several  colored 
plates.     Cloth,  ;S4.50  net ;   Half  Morocco,  ^6.00  net. 

THE    PRACTITIONER'S    OPHTHALMOLOGY 

With  few  exceptions  all  the  works  on  diseases  of  the  eye,  although  written 
ostensibly  for  the  general  practitioner,  are  in  reality  adapted  only  to  the  specialist ; 
but  Dr.  Theobald  in  his  book  has  described  very  clearly  and  in  detail  those  condi- 
tions, the  diagnosis  and  treatment  of  which  come  withm  the  province  of  the  general 
practitioner.  The  therapeutic  suggestions  are  concise,  unequivocal,  and  specific. 
It  is  the  one  work  on  the  Eye  written  particularly  for  the  general  practitioner. 

Charles  A.  Oliver,  M.D., 

Clinical  Professor  of  Ophthalmology,   Woman's  Medical  College  of  Pennsylvania. 

"  I  feel  I  can  conscientiously  recommend  it,  not  only  to  the  general  physician  and  medical 
student,  for  whom  it  is  primarily  written,  but  also  to  the  experienced  ophthalmologist.  Moat 
surely  Dr.  Theobald  bas  accomplished  his  purpose." 


F.YE,    EAR,    XOSE,    AND    THROAT. 


de  Schweinitz    and    Holloway   on   Pulsatin^^    Exoph- 
thalmos 

Pulsating  Exophthalmos.  An  analysis  of  sixty-nine  cases  not  pre- 
viously analyzed.  By  George  E.  deSchweinitz,  M.  D.,  and  Thomas 
B.  Holloway,  M.  D.     Octavo  of  125  pages.     Cloth,  $2.00  net. 

This  monograph  consists  of  an  analysis  of  sixty-nine  cases  of  this  affection 
not  previously  analyzed.  The  therapeutic  measures,  surgical  and  otherwise, 
which  have  been  employed  are  compared,  and  an  endeavor  has  been  made 
to  determine  from  these  analyses  which  procedures  seem  likely  to  prove  of 
the  greatest  value.  It  is  the  most  valuable  contribution  to  ophthalmic  liter- 
ature within  recent  years. 

British  Medical  JoumaJ 

"  The  book  deals  ver>'  thoroughly  with  the  whole  subject  and  in  it  the  most  complete  account  of 

the  disease  will  be  loiind." 

Jackson     on     the     Eye  The  New  (2d)  Edition 

A  Manual  of  the  Diagnosis  and  Treatment  of  Diseases  of  the 
Eve.  By  Edward  Jackson,  A.  IM.,  M.  D.,  Professor  of  Ophthalmology, 
University  of  Colorado.  i2mo  volume  of  615  pages,  with  184  beautiful 
illustrations.     Cloth,  I2.50  net. 

The  Medical  Record,  New  York 

"  It  is  truly  an  admirable  work.  .  .  .  Written  in  a  clear,  concise  manner,  it  bears  evidence  of  the 
author's  comprehensive  grasp  of  the  subject.  The  term  '  multum  in  parvo'  is  an  appropriate  one  to 
apply  to  this  work." 

Grant  on   Face,   Mouth,   and  Jaws 

A  Text-Book  of  the  Surgical  Principles  and  Surgical  Diseases 
OF  the  Face,  Mouth,  and  Jaws.  For  Dental  Students.  By  H.  Horace 
Grant,  A.  M.,  M.  D.,  Professor  of  Surgery  and  of  Clinical  Surgery, 
Hospital  College  of  Medicine,  Louisville.  Octavo  of  231  pages,  with 
68  illustrations.     Cloth,  $2.50  net. 

Friedrich   and   Curtis   on   Nose,   Larynx,   and   Ear 

RhINOLOGY,    LARVNGOLOGy,  AND    OtOLOGV,    AND    ThEIR    SIGNIFICANCE 

IN  General  Medicine.  By  Dr.  E.  P.  Friedrich,  of  Leipzig.  Edited 
by  H.  Holbrook  Curtis,  M.  D.,  Consulting  Surgeon  to  the  New  York 
Nose  and  Throat  Hospital.  Octavo  volume  of  350  pages.  Cloth, 
$2.50  net. 


GENITO- URINARY  AND    NOSE,     THROAT,    ETC.  9 

Greene  aiui  Brooks* 
Genito-Urinary  Diseases 

Diseases  of    the   Genito=Urinary  Organs  and  the  Kidney.      By 

Robert  H.  Greene,  M.  D.,  Professor  of  Genito-Urinary  Surgery  at 
Fordham  University ;  and  Harlow  Brooks,  M.  D.,  Assistant  Pro- 
fessor of  Clinical  Medicine,  University  and  Bellevue  Hospital  Medical 
School.  Octavo  of  605  pages,  illustrated.  Cloth,  $5.00  net;  Half 
Morocco,  ^6.50  net. 

THE  NEW    (2d)     EDITION 

This  new  work  presents  both  the  medical  and  surgical  sides.  Designed  as  a 
work  of  quick  reference,  it  has  been  written  in  a  clear,  condensed  style,  so  that 
the  information  can  be  readily  grasped  and  retained.  Kidney  diseases  are  very 
elaborately  detailed. 

New  York  Medical  Journal 

"  As  a  whole  the  book  is  one  of  the  most  satisfactory  and  useful  works  on  genito-urinary 
diseases  now  extant,  and  will  undoubtedly  be  popular  among  practitioners  and  students." 

Gleason  on  Nose,  Throat, 
and  Ear 

A   Manual   of   Diseases  of   the    Nose,  Throat,  and    Ear.     By  E. 

Baldwin  Gleason,  M.  D.,  LL.  D.,  Clinical  Professor  of  Otology, 
Medico-Chirurgical  College,  Pliiladelphia.  i2mo  of  556  pages,  pro- 
fusely illustrated.     Flexible  leather,  $2.50  net. 

FOR    PRACTITIONERS 

Methods  of  treatment  have  been  simplified  as  much  as  possible,  so  that  in 
most  instances  only  those  methods,  drugs,  and  operations  have  been  advised 
which  have  proved  beneficial.  A  valuable  feature  consists  of  the  collection  of 
formulas. 

American  Journal  of  the  Medical  Sciences 

"  For  the  practitioner  who  wishes  a  reliable  guide  in  laryngology  and  otology  there  are  few 
books  which  can  be  more  heartily  commended." 


American  Text=Boolc  of  Qenito=Urinary  Diseases,  Syphilis,  and 
Diseases  of  the  Slcin.  Edited  by  L.  Bolton  Bangs,  M.  D.,  and 
W.  A.  Hardaway,  M.  D.  Octavo,  1229  pages,  300  engravings,  20 
colored  plates.     Cloth,  ;^7.oo  net. 


SAUNDERS'     j300k^S    OX 


StelwagonV 
Diseases  of  the  Skin 


A  Treatise  on  Diseases  of  the  5kin.  By  Henry  W,  Stelwagon, 
M.  D.,  Ph.  D.,  Professor  of  Dermatology  in  the  Jefferson  Medical 
College,  Philadelphia.  Octavo  of  1135  pages,  with  258  text-cuts  and 
32  plates.     Cloth,  $6.00  net ;  Half  Morocco,  $7.50  net. 

THE    NEW    (5th)    EDITION 

The  demand  for  five  editions  of  this  work  in  a  period  of  five  years  indicates 
the  practical  character  of  the  book.  In  this  edition  the  articles  on  Frambesia, 
Oriental  Sore,  and  other  tropical  diseases  have  been  entirely  rewritten.  The  new 
subjects  include  Verruga  Peruana,  Leukemia  Cutis,  Meralgia  Paraesthetica,  Dhobie 
Itch,  and  Uncinarial  Dermatitis. 

George  T.  Elliot,  M.  D.,   Professor  of  Dermatology,  Cornell  Universily. 

"  It  is  a  liook  that  I  recommend  to  my  class  at  Cornell,  because  for  conservative  judgment, 
for  accurate  observation,  and  for  a  thorough  appreciation  of  the  essential  position  of  derma- 
tology, I  think  it  holds  first  place." 


Schamber^'s  Diseases  of  the  Skin 
arid  Eruptive  Fevers 


Diseases  of  the  Skin  and  the  Eruptive  Fevers.  By  Jay  F.  Schamberg, 
M.  D.,  I'rofessor  of  Dermatology  and  the  Infectious  Eruptive  Diseases,  Philadel- 
phia Polyclinic.     Octavo  of  534  pages,  illustrated.     Cloth,  $3.00  net. 

THE   CUTANEOUS    MANIFESTATIONS   OF  ALL   DISEASES 

"  The  acute  eruptive  fevers  constitute  a  valuable  contribution,  the  statements  made 
emanating  from  one  who  has  studied  these  diseases  in  a  practical  and  thorough  manner  from 
the  standpoint  of  cutaneous  medicine.  .  .  .  The  views  expressed  on  all  topics  are  con- 
servative, safe  to  follow,  and  practical,  and  are  well  abreast  of  the  knowledge  of  the  present 
time,  both  as  to  general  and  special  pathology,  etiology,  and  treatment." — Americiin  Journal 
of  Medical  Sciences. 


DISEASES   OF   THE  SKIN. 


Mracek  and  Stelwa^on's 
Diseases  of  the  Skin 

Atlas  and  Epitome  of  Diseases  of  the  Skin.  By  Prof.  Dr.  Franz 
Mracek,  of  Vienna.  Edited,  with  additions,  by  Henry  W.  Stelwagon, 
M.  D.,  Professor  of  Dermatology  in  the  Jefferson  Medical  College, 
Philadelphia.  With  yj  colored  plates,  50  half-tone  illustrations,  and 
280  pages  of  text.     In  Saunders"  Hand- Atlas  Series.  Clo.,  ^4. 00  net 

THE    NEW    (2d)    EDITION 

This  volume,  the  outcome  of  years  of  scientific  and  artistic  work,  contains, 
together  with  colored  plates  of  unusual  beauty,  numerous  illustrations  in  black, 
and  a  text  comprehending  the  entire  field  of  dermatology.  The  illustrations  are 
all  original  and  prepared  from  actual  cases  in  Mracek' s  clinic,  and  the  execution 
of  the  plates  is  superior  to  that  of  any,  even  the  most  expensive,  dermatologic 
atlas  hitherto  published. 

American  Journal  of  the  Medical  Sciences 

"  The  advantages  which  we  see  in  this  book  and  which  recommend  it  to  our  minds  are  : 
First,  its  handiness ;  secondly,  the  plates,  which  are  excellent  as  regards  drawing,  color,  and  the 
diagnostic  points  which  they  bring  out." 


Mracek  anb  Bangs* 
Syphilis  and  Venereal 

Atlas    and    Epitome   of    Syphilis    and    the    Venereal    Diseases. 

By  Prof.  Dr.  Franz  Mracek,  of  Vienna.  Edited,  with  additions,  by 
L.  Bolton  Bangs,  M.  D.,  late  Prof,  of  Genito-Urinary  Surgery,  Univer- 
sity and  Bellevue  Hospital  Medical  College,  New  York.  With  71 
colored  plates  and  122  pages  of  text.  Cloth,  S3. 50  net.  /;/  Saunders^ 
Hand- Atlas  Series. 

CONTAINING    71    COLORED   PLATES 

According  to  the  unanimous  opinion  of  numerous  authorities,  to  whom  the 
original  illustrations  of  this  book  were  presented,  they  surpass  in  beauty  anything 
of  the  kind  that  has  been  produced  in  this  field,  not  only  in  Germany,  but 
throughout  the  literature  of  the  world. 

Robert  L.  Dickinson,  M.  D., 

Art  Editor  of  "  The  Atnerican.  Text-Book  of  Obstetrics." 
"  The  book  that  appeals  instantly  to  me  for  the  strikingly  successful,  valuable,  and  graphic 
character  of  its  illustrations  is  the  '  Atlas  of  Syphilis  and  the  Venereal  Diseases.'     I  know  of 
nothing  in  this  country  that  can  compare  v.ith  it." 


12  S.4  L^XDE/fS'  BOOK'S   ON 

Holland's  Medical 
Chemistry  and  Toxicology 

A  Text-Book  of  Medical  Chemistry  and  Toxicology.  ]^y  James 
W.  Holland,  M.D.,  Professor  of  Medical  Chemistry  and  Toxicology, 
and  Dean,  Jefferson  Medical  College,  Philadelphia.  Octavo  of  655 
pages,  fully  illustrated.     Cloth,  ^3.00  net. 

THE  NEW  (2d)   EDITION 

Dr.  Holland's  work  is  an  entirely  new  one,  and  is  based  on  his  forty  years* 
practical  experience  in  teaching  chemistry  and  medicine.  It  has  been  subjected  to 
a  thorouj^h  revision,  and  enlarged  to  the  extent  of  some  sixty  pages.  The  additions 
to  be  specially  noted  are  those  relating  to  the  electronic  theor)-,  chemical  equilib- 
rium, Kjeldahl's  method  for  determining  nitrogen,  chemistn,-  of  foods  and  their 
changes  in  the  body,  synthesis  of  proteins,  and  the  latest  improvements  in  urinary 
tests.      More  space  is  given  to  toxicology  than  in  any  other  text-book  on  chemistry. 

American  Medicine 

"  Its  statements  are  clear  and  terse ;  its  illustrations  well  chosen;  its  development  logical, 
systematic,  and  comparatively  easy  to  follow.  .  .  .  We  heartily  commend  the  work." 

Grtinwald  and  Newcomb's 
Mouth,  Pharynx,  and  Nose 

Atlas  and    Epitome   of  Diseases   of  the   Mouth,   Pharynx,  and 

No»e.  By  Dr.  L.  Grunwald,  of  Munich.  From  the  Second  Revised 
and  Enlarged  German  Edition.  Edited,  with  additions,  by  James  PI 
Newcomb,  M.  D.,  Instructor  in  Laryngology,  Cornell  University  Medical 
School.  With  102  illustrations  on  42  colored  lithographic  plates,  41 
text-cuts,  and  219  pages  of  text.  Cloth,  ;$3.oo  net.  In  Saunders' 
Hand-Atlas  Series. 

INCLUDING   ANATOMY   AND    PHYSIOLOGY 

In  designing  this  atlas  the  needs  of  both  student  and  practitioner  were  kept 
constantly  in  mind,  and  as  far  as  possible  typical  cases  of  the  various  diseases 
w«re  selected.  The  illustrations  are  described  in  the  text  in  exacdy  the  same  way 
as  a  practised  examiner  would  demonstrate  the  objective  findings  to  his  clg-ss. 
The  illustrations  themselves  are  numerous  and  exceedingly  well  executed.  The 
editor  has  incorporated  his  own  valuable  experience,  and  has  also  included  exten- 
sive notes  on  the  use  of  the  active  principle  of  the  suprarenal  bodies. 

American  Medioae 

"  Its  conciseness  without  sacrifice  of  clearness  and  thoroughness,  as  well  as  the  exceUence 
of  t«xt  and  illustrations,  are  commendable." 


URINE  AND   IMPOTENCE.  13 


Ogden  on  the  Urine 


Clinical  Examination  of  Urine  and  Urinary  Diagnosis.  A  Clinical 
Guide  for  the  Use  of  Practitioners  and  Students  of  Medicine  and  Sur- 
gery. By  J.  Bergen  Ogden,  M.  D.,  Medical  Chemist  to  the  Metro- 
politan Life  Insurance  Company,  New  York.  Octavo,  418  pages,  54 
text  illustrations,  and  a  number  of  colored  plates.     Cloth,  ;$3.00  net. 

JUST  READY— THE   NEW   (3d)    EDITION 

In  this  edition  the  work  has  been  brought  absolutely  down  to  the  present  day. 
Urinary  examinations  for  purposes  of  life  insurance  have  been  incorporated,  because 
a  large  number  of  practitioners  are  often  called  upon  to  make  such  analyses. 
Special  attention  has  been  paid  to  diagnosis  by  the  character  of  the  urine,  the 
diagnosis  of  diseases  of  the  kidneys  and  urinary  passages  ;  an  enumeration  of  the 
prominent  clinical  symptoms  of  each  disease  ;  and  the  peculiarities  of  the  urine 
in  certain  general  diseases. 

The  Lancet,  London 

"  We  consider  this  manual  to  have  been  well  compiled  ;  and  the  author's  own  exp)erience, 
so  clearly  stated,  renders  the  volume  a  useful  one  both  for  study  and  reference." 

Vecki's  Sexual  Impotence 


The  Pathology  and  Treatment  of  Sexual  Impotence.  By  Victor 
G.  Vecki,  M.  D.  From  the  Second  Revised  and  Enlarged  German 
Edition.      i2mo  volume  of  329  pages.     Cloth,  ^2.00  net. 

THIRD   EDITION.  REVISED   AND   ENLARGED 

The  subject  of  impotence  has  but  seldom  been  treated  in  this  country  in  the 
truly  scientific  spirit  that  its  pre-eminent  importance  deserves,  and  this  volume  \vill 
come  to  many  as  a  revelation  of  the  possibilities  of  therapeutics  in  this  important 
'field.  The  reading  part  of  the  English-speaking  medical  profession  has  passed 
judgment  on  this  monograph.  The  whole  subject  of  sexual  impotence  and  its 
treatment  is  discussed  by  the  author  in  an  exhaustive  and  thoroughly  scientific 
manner.  In  this  edition  the  book  has  been  thoroughly  revised,  and  new  matter 
has  been  added,  especially  to  the  portion  dealing  with  treatment. 

Johns  Hopkins  Hospital  Bulletin 

"  A  scientific  treatise  upon  an  important  and  much  neglected  subject.  .  .  .  The  treatment 
of  impotence  in  general  and  of  sexual  neurasthenia  is  discriminating  and  judicious." 


14  .sVKaV'AVvW    JiOOA'S    ON 

Wells*   Chemical  Pathology 

Chemical  Pathology.  Being  a  discussion  of  General  Path- 
ology from  the  Standpoint  of  the  Chemical  Processes  Invoked. 
By  H.  Gideon  Wells.  Ph.D.,  M.  D.,  Assi.stant  Professor  of 
Pathology  in  the  University  of  Chicago.  Octavo  of  549  pages. 
Cloth,  $3.25  net ;   Half  Morocco,  $4.75  net. 

Dr.  Wells  here  concisely  presents  the  latest  work  systematically  con- 
sidering the  subject  of  general  pathology  from  the  standpoint  of  the  chemical 
processes  involved.  Special  chapters  are  devoted  to  Diabetes  and  to  Uric- 
acid  Metabolism  and  Gout. 

Wm.   H.  Welch,   M.  D.,  Professor  of  Pathology,  Johns  Hopkins  University. 

"  The  work  fills  a  real  need  in  the  English  literature  of  a  very  important  subject,  and 
I  shall  be  glad  to  recommend  it  to  my  students." 


Just  Ready 
The  New   (2d  1   Edition 


Saxe*s  Urinalysis 

Examination  of  the  Urine.  By  G.  A.  De  S.vntos  Saxe,  M.  D.. 
Instructor  in  Gcnito-Urinary  Surgerx',  York  Post-graduate  Medical 
School  and  Hospital.  I2m()  of  448  pages,  fully  illustrated. 
Cloth,  $175  net. 

This  work  is  intended  as  an  aid  in  diagnosis,  by  interpreting  the  clinical 
significance  of  the  chemic  and  microscopic  urinary  findings. 

Francu  Carter  Wood,   M.  D.,    Adjunct   Professor  of  Clinical  Pathology,   Columbia   Uni- 

versitv. 

"It  seems  to  mc  to  be  one  of  the  best  of  the  smaller  works  on  this  subject ;  it  is, 
indeed,  better  than  a  good  many  of  the  larger  ones." 

deSchweinitz  and  Randall   on  the  Eye,  Ear, 
Nose,  and  Throat 

American  Text-Book  of  Diseases  of  the  Eye,  Ear,  Nose,  and 
Throat.  P^dited  by  G.  E.  de  Schweinitz,  M.  D.,  Professor  of 
Ophthalmology  in  the  University  of  Penn.sylvania  ;  and  B.  Ale.x- 
ANDER  R.\NDALL,  M.  D.,  Clinical  Professor  of  Diseases  of  the  Ear 
in  the  University  of  Pennsylvania.  Imperial  octavo,  1251  pages, 
with  766  illustrations,  59  of  them  in  colors.  Cloth,  ;^7.oo  net ; 
Half  Morocco,  $8.50  net. 

Griinwald  and  Grayson  on  the  Larynx 

Atlas  and    Epitome  of  Diseases  of   the   Larynx.     By  Dr.  L. 

Grunwald,  of  Munich.  Edited,  with  additions,  by  Charles  P. 
Grayson,  M.  D.,  Clinical  Professor  of  Laryngology  and  Rhinology, 
University  of  Pennsylvania.  With  107  colored  figures  on  44 
plates,  25  text-cuts,  and  103  pages  of  text.  Cloth,  ^2.50  net. 
In  Saunders'  Hand-Atlas  Series, 


CHEMISTRY,   SKIN,   AND    VENEREAL    DISEASES.  15 

American  Pocket  Dictionary        sixth  Edition— Recently  issued 

The  American  Pocket  Medical  Dictionary.  Edited  by  W.  A. 
Newman  Borland,  M.  D.,  Assistant  Obstetrician  to  the  Hospital 
of  the  University  of  Pennsylvania.  Containing  the  pronunciation 
and  definition  of  the  principal  words  used  in  medicine  and  kindred 
sciences.  598  pages.  Flexible  leather,  with  gold  edges,  ;^i.oo 
net;  with  thumb  index,  ^1.25  net. 
James  W.  Holl&nd.  M.  D., 

Professor  of  Medical  Chemistry  and  Toxicology,  and  Dean,  Jefferson  Medical  College, 
Philadelphia, 

"  I  am  struck  at  once  with  admiration  at  the  compact  size  and  attractive  exterior.  I 
can  recommend  it  to  our  students  without  reserve." 

Stelwagon's  Essentials  of  Skin  just  Ready— 7th  Edition 

Essentials  of  Diseases  of  the  Skin.  By  Henry  W.  Stel- 
WAGON,  M.  D.,  Ph.D.,  Professor  of  Dermatology  in  the  Jeffer- 
son Medical  College,  Philadelphia.  Post-octavo  of  291  pages, 
with  72  text-illustrations  and  8  plates.  Cloth,  ^^i.oo  net.  A' 
Saunders'  Question- Comp end  Series. 
The  Medical  News 

"  In  line  with  our  present  knowledge  of  diseases  of  the  skin.  .  .  .  Continues  to  main- 
tain the  high  standard  of  excellence  for  which  these  question  compends  have  been  noted." 

Wolffs  Medical  Chemistry  New  (7th)  Edition 

Essentials  of  Medical  Chemistry,  Organic  and  Inorganic. 
Containing  also  Questions  on  Medical  Physics,  Chemical  Physiol- 
ogy, Analytical  Processes,  Urinalysis,  and  Toxicology.  By  Law- 
rence Wolff,  M.  D.,  Late  Demonstrator  of  Chemistry,  Jefferson 
Medical  College.  Revised  by  A.  Ferree  Wither,  Ph.  G.,  M.  D., 
Formerly  Assistant  Demonstrator  of  Physiology,  University  of 
Pennsylvania.  Post-octavo  of  222  pages.  Cloth,  ^i.oo  net.  In 
Saimders'  Question- Compend  Series. 

Martin's  Minor  Surgery,  Bandaging,  and  the  Venereal 

Diseases  second  Edition.  Revised 

Essentials  of  Minor  Surgery,  Bandaging,  and  Venereal 
Diseases.  By  Edward  Martin,  A.  M.,  M.  D.,  Professor  of  Clin- 
ical Surgery,  University  of  Pennsylvania,  etc.  Post-octavo,  166 
pages,  with  78  illustrations.  Cloth,  ;^i.oo  net.  In  Saunders' 
Question- Compend  Series. 


1 6  URINE,   EVE,   EAR,   NOSE,   AND    77/ROAT. 

Wolfs  Examination  of  Urine 

A  Laijukatoky  Handbook,  of  Physiologic  Chemistry  and 
Urine-examination.  By  Charles  G.  L.  Wolf,  M.  D.,  In.structor  in 
Physioloi^ic  Chcmi.stry,  Cornell  University  Medical  College,  New 
York.  1 2mo  volume  of  204  pages,  fully  illustrated.  Cloth,  $1.25  net. 
British  Medical  Journal 

■  riu-  methods  uf  examining  the  urine  are  very  fully  described,  and  there  are  at  the 
end  of  the  book   some   extensive   tables  drawn  up  to  assist  in  urinary  diftgncsis." 

Jackson's  Essentials  of  Eye  Third  Revised  Edwon 

Kssentials  of  Refkactio.v  and  of  Diseases  of  the  Eve.  By 
Edward  Jackson,  A.  M.,  M.  D.,  Emeritus  Professor  of  Diseases  of 
the  P^yc,  Philadelphia  Polyclinic.  Post-octavo  of  261  pages,  82  illus- 
trations. Cloth,  $1.00  net.  In  Saunders'  Qucstion-Coinpend  Series. 
Johns  Hopkins  Hospital  Bulletin 

"  The  entire  ground  is  covered,  and  the  points  that  most  need  careful  elucidation 
are  made  clear  and  easy." 

Gleason's  Nose  and  Throat  Fourth  Edition.  Revised 

EssENTiAi„s  OF  Diseases  of  the  Nose  and  Throat.  V>y  IC.  1^. 
Gleason,  S.  B.,  M.  D.,  Clinical  Professor  of  Otology,  Mcdico- 
Chirurgical  College,  Philadelphia,  etc.  Post-octavo,  241  pages,  1 12 
illustrations.  Cloth,  $1.00  net.  I)i  Sannders"  Question  Compends, 
The  Lancet,  London 

"  The  careful  description  which  is  given  of  the  various  procedures  would  be  sufficient 
to  enable  most  people  of  average  intelligence  and  of  slight  anatomical  knowladge  to 
make  a  very  good  attempt  at  laryngoscopy." 

Gleason's  Diseases  of   the  Ear  Third  Edition.  Revised 

Essentials  of  Diseases  of  the  P>ar.     By  Y..  Vi.  Gleason,  S.  B., 
M.  D.,  Clinical  Professor  of  (3tology,  Mcdico-Chirurgical  College, 
Phila.,  etc.     Post-octavo   volume  of  214  pages,  with    114  illu.stra- 
tions.     Cloth,  3 1. 00  net.      /;/  Saunders'  Question- Compend  Series. 
Bristol  Medico-Chirurgical  Journal 

"  We  know  of  no  other  small  work  on  ear  diseases  to  compare  with  this,  either  in 
freshness  of  style  or  completeness  of  information." 

>fVilcox  on  Genito-Urinary  and  Venereal  Diseases 

Just  Ready— The  New  (2d)  Edition 

Essentials  of  Genito-Urinary  and  Venereal  Diseases.  By 
Starling  S.  Wilcox,  I\I.  D.,  Lecturer  on  Genito-Urinary  Diseases 
and  Syphilology,  Starling-Ohio  Medical  College,  Columbus.  1 2mo 
of  321  pages,  illustrated.     Cloth,  $1.00  net.     Saunders'  Compends. 

Stevenson*s  Photoscopy 

Photoscofy  (Skiascopy  or  Retinoscopy).  By  Mark  D.  Stev- 
enson, M.  D.,  Ophthalmic  Surgeon  to  the  Akron  City  Hospital. 
i2mo  of  126  pages,  illustrated.  Cloth,  $1.25  net. 

Edward  Jackson.  M.  D.,  University  of  Colorado. 

"  It  is  well  written  and  will  prove  a  valuable  help.  Your  treatment  of  the  emergent 
j>encil  of  rays,  and  the  part  failing  on  the  examiner's  eye,  is  decidedly  better  than  any 
previous  account," 


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